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Reference  Hibvavv 


'S?'^^-^<J^yf-.^<-^U , 


Digitized  by  the  Internet  Archive 

in  2010  with  funding  from 
Columbia  University  Libraries 


http://www.archive.org/details/dentalpathologyOOingl 


DENTAL  PATHOLOGY 


THERAPEUTICS 


IN   THE  FOKM   OF 


QUESTIONS    AND    ANSWERS 


COBIPILED   BY 


OTTO  E.  INGLIS,  D.  D.  S. 


CABEFULLY  REVISED  AND  APPROVED 
BY 

J.  FOSTER  ELAGG,    D.D.S. 

PROFESSOR    OF    DENTAL    PATHOLOGY    AND    THERAPEUTICS    IN 
PHILADELPHIA    DENTAL    COLLEGE 


PHILADELPHIA 

1887 


COPYRIGHT, 

OTTO  E.  INGLIS, 

1887. 

ALL  EIGHTS    RKSERVED. 


Printed  by  A.  T.  Zeising  &  Co.,  Philadelphia. 
Electrotyped  by  Duncan  &  Pvoss. 


CONTENTS. 


GENERAL    PRINCIPLES. 

Life  Force,  1;  Means  and  Theory  of  Eelief,  4;  PreHxes  and  SufiSxes,  6; 
Principles  and  Practice  of  Dentistry,  7;  Dental  Pathology  and  Thera- 
peutics, 8;  Definitions  of  Disease,  Etiology,  etc.,  9;  Signs  and  Symp- 
toms, 11;  Intrinsic  and  Extrinsic  Precedents  to  Disease,  12;  Predis- 
posing and  Exciting  Causes,  14 ;  Elements  of  Disease — Primary  and 
Proximate,  24 ;  Special  Medicinal  Stimuli,  Cathartics,  etc.,  29;  Blood — 
How  Obtained,  How  Eeplenished,  43;  Pulse,  Its  Varieties  and  Normal 
Frequency,  44;  Constituents  of  Normal  Blood,  47;  Divisions  of  Blood, 
48  ;  Anaemia,  58 ;  Plethora,  65 ;  Determination  of  Blood,  73 ;  Conges- 
tion of  Blood,  78 ;  True  Inflammation,  81 ;  Classes,  Duration  and 
Causes  of  Inflammation,  84;  Eeaction,  90;  Results  and  Terminations 
of  Inflammatory  Action,  9:!.;  Adynamia,  108. 

DECIDUOUS    TEETH. 

Anatomical  and  Physiological  Divisions  of  Teeth,  109 ;  Faces  of  Teeth,  112; 
Functions  of  Pulp  and  Pericementum,  113;  Eruption  of  Deciduous 
Teeth,  115;  Pathological  Dentition — Symptoms  and  Terminations,  117; 
Remedy — Lancing,  125;  Hemorrhage  After  Lancing,  142;  Dangerous 
Period  During  Dentition,  146;  Indications  for  Extraction  of  Deciduous 
Teeth,  147. 

PERMANENT    TEETH. 

Eruption  of,  149;  Pathological  Eruption  of  Upper  Wisdom,  150;  Patholog- 
ical Eruption  of  Lower  "Wisdom,  151;  Extraction  of  Six -Year  Molars, 
155. 

DENTAL    CARIES. 

Dental  Caries,  156;  General  and  Local  Causes,  157;  Periodicity  of  Decay, 
165;  Eftect  of  Decayed  Teeth  Upon  Others,  167;  Sex  in  Caries,  168; 
Tobacco,  169;  Theory  Taught,  170;  Prophylactic  Treatment,  171; 
Relative  Liability  of  Teeth  to  Decay,  174;  Methodic  Examination, 
Positions  for  Caries,  176. 

Odontalgia.— Causes,  182,  290,  351,  395. 

(iii) 


iv  CONTENTS. 


Sensitive  Dentine. — Classes  Discussed  Under,  183;  Symptoms  and  Diag- 
nosis, 184. 

Cases  With  No  Perceptible  Cavities  of  Decay. — Locations  and 
Appearance,  187;  Acids  as  Cause  of  Sensitive  Dentine,  etc.,  189;  Its- 
Treatment,  190 ;   Neuralgic  Complications  from  Sensitive  Dentine,  192- 

SuPERFiciAL  Caries. — Eemoval  of,  194  ;  Sensitive  Dentine  in,  195. 

Simple  Caries. — Eemedies  for  Sensitive  Dentine,  198 ;  Topical  Applications 
— Not  Dangerous  to  Pulp,  203;  Those  Possibly  Dangerous,  210;  Those 
Liable  to  be  Dangerous,  211;  Chloride  of  Zinc,  213 ;  Carbonate  of  Potas- 
sium, 230;  Chromic  Acid,  236;  Ethylate  of  Sodium,  243;  That 
Dangerous — Arsenic,  245;  Pulp-Protectors,  249;  Zinc  Phosphates,  251; 
Systematic  Consecutive  Obtunding,  252 ;  Heat,  Cold,  Electricity,  254 ; 
Systemic  Treatment,  263 ;   Anaesthesia,  264. 

Deep-Seated  Caries. — Deep-Seated  Caries,  197;  Condition  and  Treatment 
of  Cavities,  268;  Syringing,  273;  White,  Yellow  and  "Horny"  Decay, 
274;  Conservation  of  Decay,  278,  301;  Materials  for  Filling,  282;. 
Dangers  Prospective  After  Filling,  284 ;  Recalcification,  Tubular  Con- 
solidation, Secondary  Dentine,  286;  Pulp  Irritation,  290,  316,  354;. 
Spontaneous  Pain,  299;  Pulp  Conservation,  307,  393;  Success  and 
Failure,  308;  Remedies,  Intermediates,  etc.,  317;  Gradations  of  Decay 
to  Exposed  Pulp,  321 ;  Controlling  Influences  in  Pulp  Conservation, 
323 ;  Age,  Temperament,  324 ;  Dental  Temperaments,  339  ;  Physical 
Condition,  Over-exertion,  Sex,  etc.,  340;  Third  Cause  of  Odontalgia, 
351 ;  Periodicity,  353  ;  Diagnosis  of  Exposed  Pulp,  355 ;  Medicaments 
Used  for  Soothing  Pulps,  372. 

Pulp  Capping. — 373;  Qualities  of  Cappers,  376;  Cappers,  379-388; 
Time  Allowed  Before  Success  Pronounced,  389;  Lingering  Death  of 
Pulp,  392 ;  Pulp  Irritation  from  Disease  of  Surrounding  Parts,  397 ; 
Pulp  Irritation  from  Abrasion,  398;  Cupping  on  Edges  of  Teeth,  401; 
Causes  of  Fracture  of  Teeth,  404. 

Absorption  of  Permanent  Roots,  405. 

Pulp  Nodules,  406-414. 

Fungous  Gum  and  Fungous  Pulp,  415-423. 

COMPLICATED    CARIES. 

Pulpless  Te6th  Not  Dead  Teeth,  425 ;  Dead  Teeth,  427  ;  Results  of  Death 
of  a  Pulp,  431 ;  Discoloration  of  Tooth,  433;  Pulpless  Teeth  Sometimes 
Better  Than  Teeth  Wholly  Vital,  438. 

Devitalization  of  Dental  Pulp. — Cauterization,  440 ;  Instrumentation, 
442;  Luxation,  443;  Arsenic,  444;  Tests  for,  447;  Characteristics  of, 
450 ;    When   Introduced,  451  ;  Arsenic   as   a   Vital   Irritant,  452 ;    Its 


CONTENTS. 


Action  Internally,  454  ;  Swallowing  an  Arsenical  Application,  457  ;  Sys- 
temic Action  from  Local  Application, 458 ;  Action  Upon  the  Gum  Tissue, 
460;  Forms  in  Which  Arsenic  is  Used,  463;  The  Application  of  Arse- 
nic for  Pulp  Devitalization,  464  ;  Proper  Preparation,  465 ;  Proper  Plac- 
ing, 468  ;  Devitalizing  Fibre,  471 ;  Pockets,  472  ;  Proper  Guarding,  474  ; 
Proper  Maintenance  in  Position,  479 ;  Time  Needful  and  Possible  for 
Arsenical  Applications,  480  ;  Action  of  Arsenic  Upon  the  Pulp,  484  ;  Peri- 
dental Irritation  as  a  Eesult  of  Arsenical  Devitalization,  491 ;  Absorp- 
tion of  Arsenic  by  the  Pulp,  492,  500  ;  Suffusion,  493 ;  Eepeated  Appli- 
cations of  Arsenic,  495 ;  Intractable  Pulp,  493 ;  Devitalization  of 
Deciduous  Pulps  by  Pressure,  498 ;  Calcification  and  Decalcification  of 
Eoots,  502 ;  Antagonistic  Treatment  of  Deciduous  and  Permanent 
Teeth,  503. 

Pulsating  Pulps,  504-509. 

EXTIEPATION  OF  DENTAL  PULP. — Success  in,  510  ;  Essentials  for,  511  ; 
Tapping,  512;  Sensation  in,  515;  Broken  Broaches  in  Canals,  517; 
Treatment  of  Single-Eooted  Teeth,  520 ;  Treatment  of  Multirooted 
Teeth,  522  ;  Partial  Devitalization,  516,  523;  Medicaments  for  Canals, 
524 ;  Stopping  Tooth,  525 ;  Hemorrhage,  526  ;  Peculiarities  of  Eoot 
Formation,  527  ;  Extirpation  of  Deciduous  Pulps,  529  ;  Probabilities 
and  Possibilities  of  Pulpless  Tooth,  530. 

EXOSTOSED,   FUSED,  ATTACHED   AND    GEMINOUS 

TEETH. 

Dental  Exostosis,  533;  Form  of,  537 ;' Causes  of,  542  ;  Symptoms  of, 
545;  Sympathetic  Trouble  from,  546;  The  Fifth  Pair  of  Nerves,  547; 
Treatment,  548 ;  Fractures  from  Extracting  Exostosed  Teeth,  549. 

Fused  Teeth. — Causes  and  Symptoms,  553-555. 

Attached  Teeth,  556. 

Geminous  Teeth,  557-560. 

PERIODONTITIS. 

stages  of  Inflammation  Included  in  the  Term,  562 ;  General  Dental  Hyperses- 
thesia,  563  ;  The  Cause  of  Periodontitis,  567 ;  The  Five  Grades  of  Perio- 
dontitis, 568  ;  The  Seventeen  Recognized  Causes,  569  ;  "Want  of  Occlusion, 
570 ;  Mal-occlusion,  571 ;  The  Natural  Moving  Tendency  of  Teeth  in  the 
Mouth,  572  ;  Salivary  Calculus  and  Tartar,  573  ;  Loose  Tooth  or  Eoot, 
575 ;  Induration  of  Tooth  Tissue;  576 ;  Cavities  of  Decay  Impinging 
Upon  the  Cementum,  579;  Treatment  of  Hypertrophied  Gum,  580; 
Mechanical  Irritation,  581 ;  Split  Teeth,  582;  Dental  Manipulation, 
583 ;  Excess  of  Filling  Material,  584 ;  Inflammation  of  Pulp,  591 ; 
Varieties  of  Hemorrhage,   595 ;   Forcible   "Withdrawal   of  Pulp,   599 ; 


VI  CONTENTS. 


Putrescent  Pulp,  601 ;  Clouding,  603  ;  Time  Eequired  for  Putrescence  of 
a  Devitalized  Pulp,  605  ;  Venting,  608  ;  Counter-Pressure,  613  ;  Treat- 
ment of  Tooth  After  Venting,  614 ;  Previous  Periodontitis,  616 ; 
Re-establishment  of  Normality  in  Diseased  Tissue,  618 ;  Periodontitis 
from  Sympathy,  619;  Action  of  Medicine  Locally,  622;  Action  of 
Medicine  Systemically,  624  ;  Action  of  Virus,  628  ;  Signs  and  Symp- 
toms of  Periodontitis,  629  ;  The  Health  Line,  630  ;  The  Treatment  of 
Periodontitis,  633  ;  Acute  and  Chronic,  634  ;  Chronic  Forms  of  Perio- 
dontitis, 636  ;  Prophylactic  Treatment — Local  and  General,  638  ;  Treat- 
ment for  Second-Grade  Periodontitis,  642;  Treatment  for  Third  Grade, 
643;  The  Gutta-Percha  Guard,  645;  The  Eubber-Dam  Guard, 
646;  The  "H"  Guard,  647;  The  Block  Guard,  648;  The  Filling 
Guards,  649 ;  The  Placing  of  Guards,  650 ;  Local  Sedation,  651 ; 
Local  Medication,  652 ;  Drilling  Apical  Vent,  653 ;  Constitutional 
Medication,  656  ;  Antiseptic  Treatment  of  Canals  After  Cure  of  Perio- 
dontitis, 658  ;  Systematic  Stopping  and  Unstopping,  660  ;  Condition  of 
Tooth  After  Cure  of  Periodontitis,  664 ;  Stimulation  for  Suppuration, 
666,  675;  Fourth -Grade  Periodontitis,  666;  Chronic  Periodon- 
titis, 667 ;  The  Results  of  Chronic  Periodontitis — Watery  Effusions, 
Indurations,  671. 

ALVEOLAR   ABSCESS. 

Causes  for,  680  ;  Condition  of  Tooth  After  Cure,  681 ;  Location  of  an  Alveo- 
lar Abscess,  683,  698  ;  Signs  and  Symptoms  of  Acute  Alveolar  Abscess, 
686  ;  Signs  and  Symptoms  of  Chronic  Alveolar  Abscess,  688 ;  Ways  in 
Which  an  Abscess  May  Discharge  Its  Pus,  689 ;  Prognosis  of  Alveolar 
Abscess,  690;  Possible  Sequelae,  692;  Palliative  Treatment,  694; 
Curative  Treatment,  695;  Treatment  of  Tooth  With  and  Without  a  Fistulous 
Opening,  696;  Injections  for  Fistulse,  696;  Diagnosis  and  Treatment  of 
Abscess  in  a  Bifurcation,  699  ;  Canal  Medicaments,  702  ;  Treatment  of 
Abscess  With  External  Fistula,  703  ;  Treatment  of  Abscess  if  Sac  be 
Left  After  Extraction  of  Tooth,  708. 

CARIES   AND   NECROSIS. 

Diagnosis  and  Treatment  of  Carious  Bone,  709  ;  Diagnosis  of  Necrosis  of 
Alveolar  Process,  711 ;  Cause  and  Treatment  of  Caries  of  Alveolar 
Walls,  712 ;  Lesions  Occasioned  by  Dead  Teeth,  714  ;  Diagnosis  of 
Portion  of  Root  Within  Alveolus,  715. 

PYORRH(EA   ALVEOLARIS. 

Cause,  717;   Treatment,  718;   Prognosis,  719. 

MEDICAMENTS. 

Arranged  in  alphabetical  order. 


DENTAL  PATHOLOGY 

AND 

THERAPEUTICS. 


GENERAL  PRINCIPLES. 

1.  Question. — What  is  that  force  called  upon  Avhich  depends 
all  response  to  remedial  efforts  ? 

Answer. —  Vis  T'zYce  (life  force). 

2.  What  is  this  force  called  as  a  conservator? 
Vis  Conservatrix  Naturoe. 

3.  What  as  a  medicator? 
Vis  Medicatrix  Naturce. 

4.  What  is  the  employment  of  indicated  means  for  relief  called  ? 
Ars  Medendi. 

5.  What  is  the  theory  of  relief  called  ? 
Ratio  Medendi. 

G.  What  are  the  meanings  and  uses  of  the  prefixes  "hyper," 
"hypo,"  "a"  or  "  an,"  "epi,"and  the  suffixes  "itis"  and  "algia?" 

"Hyper,"  above,  excessive;  "hypo,"  under,  beneath,  defi- 
ciency; "a"  or  "an,"  without,  lacking;  "  epi,"  upon,  on; 
"itis,"  inflammation;   "algia,"  pain. 

7.  Define  the  "Principles  and  Practice  of  Dentistry." 

Such  application  of  general  facts  as  is  subservient  to  the 
requirements  of  dentistry. 

8.  What  is  "  Dental  Pathology  and  Therapeutics?  " 

Dental  pathology  considers  the  causes  and  different  forms 
of  the  various    diseases  to   which   the   teeth   are   liable;    dental 

(1) 


DENTAL    PATHOLOGY    AXD    THERAPEUTICS. 


therapeutics  considers  the  methods  and  medicaments  used  in  the 
treatment  of  such  diseases. 

9.  Define  the  terms  "Disease,"  "Etiology,"  "Semiology" 
and  "Nosology." 

"Disease,"  alteration  of  nutrition;  "etiology,"  causes  of 
disease;  "semiology,"  the  symptoms  and  signs  of  disease; 
"nosology,"  the  classification  of  diseases. 

10.  Define  the  terms  "Diagnosis"  and  "Prognosis." 
"Diagnosis,"  distinction  of  disease;   "prognosis,"  the  foretell- 
ing of  the  probable  and  possible  progress  and  termination  of  disease. 

11.  What  are  signs  ?     What  are  symptoms? 

Signs  are  indications  which  can  be  seen;  symptoms  are  feelings 
as  described  by  patients. 

12.  What  is  the  first  natural  division  of  essential  precedents  to 
disease  ? 

"Intrinsic"  and  "Extrinsic." 

13.  What  is  the  meaning  of  these  terms  ? 

"Intrinsic,"  excess  or  deficiency  of  functional  action  or  of 
some  constituent  of  the  economy;  "extrinsic,"  external  agencies 
which  have  power  to  act  on  either  mind  or  body. 

14.  What  is  the  second  natural  division  of  these  causes  ? 
"Predisposing"  and  "Exciting." 

15.  What  are  predisposing  causes? 

Circumstances  which  influence  function  or  structure  unfa- 
vorably, yet  short  of  actual  disease. 

16.  What  are  exciting  causes? 

Causes  which  of  themselves  induce  disease,  or  which  promote 
the  resulting  effect  of  the  predisposing  cause. 

17.  Are  the  predisposing  and  exciting  causes  both  necessary  for 
disease  ? 

As  a  rule  they  are. 

18.  Name  an  example  where  both  are  not  necessary. 
A  splinter  in  the  flesh  is  an  exciting  cause  only. 

19.  Are  these  causes  susceptible  of  transposition? 

Yes ;  an  exciting  cause  may  be  at  times  a  predisposing  cause, 
and  vice  versa. 

20.  Give  an  example. 

Debilitating  exposure  to  cold  may  predispose  to  diarrhoea 
from    indigestible    ingesta.       Transposition — One     predisposed 


MEMORANDA. 


MEMORANDA. 


GENERAL    PRINCIPLES. 


through    irritability    of  the    intestines   will   incur    diarrhoea   by 
exposure  to  cold. 

21.    Name   the   predisposing  causes  of   disease,    according  to 
Williams. 


1.  Debilitating  influences. 

2.  Excitement. 

3.  Previous  disease. 

4.  Present  disease. 

5.  Hereditary  constitution. 


6.  Temperament. 

7.  Age. 

8.  Sex. 

9.  Occupation. 


22.  Into  what  two  classes  are  the  excitins;  causes  of  disease 
divided  ? 

"  Cognizable  "  and  "  Non-cognizable." 

23.  Name  some  of  each,  according  to  Williams. 

f  1.   MechanicaL 

2.  Chemical. 

3.  Ingesta. 

4.  Bodily  exertion. 

5.  Mental  emotion. 

6.  Excessive  evacuation. 

7.  Suppressed  or  defective  evacuation. 

8.  Defective  cleanliness,  ventilation  and  drainage. 

9.  Temperature  and  changes. 

1.   Endemic. 


cognizabl]-; 

Causes. 


non-cognizabl 
Causes. 


:,Ef 
1 


2.  Epidemic. 

3.  Infectious. 


Poisons. 


24.  What  are  the  "elements"  of  disease? 

Functional,  structural,  circulatory  and  nutrient  departures  from 
normality. 

25.  What  is  the  division  of  the  "elements"  of  disease? 
Into  "Primary"  and  "Proximate." 

26.  Name  the  primary  elements  of  disease. 


Structural. 
COXTRACTILE  FiBRE, 

Nervous  Structure, 
Secretory  Tissue, 


Functional. 
Irritability. 
Tonicity. 

I   SensibilitJ^ 
i   Voluntary  motion. 
I   Reflex  action. 
t  Sympathy. 

Secretion. 


1 


Excessive. 

[-  Defective. 

Abnormal. 


DENTAL    PATHOLOGY    AND    THERAPEUTICS. 


27.  Name  the  proximate  elements  of  disease. 


r  Defective, 
"Ansemia." 


Blood 

IN 

Circulation. 


iu 


Excessive, 


General. 
LocaL 

GeneraL 


Plethora." 


t  Local. 

Perverted,  "Cachoemia." 
"Defective,  "Atrophy." 


Nutrition  of 
Tissues. 


r  a  Increased, 
J  I      "Sthenic." 
g  Diminished, 
o      "  Asthenic." 


r      Increased, 
j    ^      "Determination." 
.2  Diminished, 
9      "Congestion." 
I  .§  Partly  increased  and 
I  partly  diminished, 

"Inflammation." 
I  Terminations  of  lu- 
1  flammation : 

"Eesolution," 

"Suppuration," 

"Gangrene,"  ]    °^ 

"Mortification,"    ,    j"  '°''* 
I       "  Sloughing,"  (?)t    -  '''"'''■ 

"Caries,"  ->    of 

I       "Necrosis,"  I  hard 

L       "  Exfoliation."  (?)tj  parts. 


Excessive,  "Hypertrophy." 


Perverted. 


I 


Degenerations. 
1  Depositions. 
1^  Growths. 


28.  What  is  the  difference  between  a  primary  and  a  proximate 
element  of  disease  ? 

The  former  considers  the  pathological  condition  of  a  certain 
function  or  structure;  the  latter  considers  the  diseases  (jf  the 
circulation  and  the  consequent  effects  upon  tissue. 

29.  Into  what  classes  are  special  medicinal  stimuli  generally 
divided  ? 

"  Cathartics,"  "  Diuretics,"  "  Diaphoretics  "  and  "  Sudorifics," 
"Expectorants,"  "  Sorbefacients,"  "  Emmenagogues,"  "  Siala- 
gogues,"  "Errhines." 

30.  What  are  "  cathartics  ?  " 

Medicines  which  increase  the  alvine  discharges. 


*  WiUiams'  Principles  of  Medicine— Clymer,  pp.  92  and  93. 

t  Questionalile  terminations  dependent  upon  systemic  power  or  necessary  interference. 


MEMORANDA. 


MEMORANDA. 


GENERAL    PRINCIPLES. 


31.  How  are  they  divided? 

Into  "  Laxatives  "  or  "Aperients,"  and  "Purgatives,"  accord- 
ing as  they  act  mildly  or  decidedly. 

32.  What  peculiarity  of  action  pertains  to  these  ? 

Some  act  upon  the  superior  portion  of  the  intestines  (exam- 
ple— calomel)  ;  some  upon  the  inferior  portion  (example — 
aloes) ;  others  upon  the  whole  extent  of  intestines  (exam- 
ple— sulphate  of  magnesia). 

33.  What  are  "  diuretics  ?  " 

Medicines  which  increase  the  secretion  of  the  urine. 

34.  What  are  "  diaphoretics  ?  " 
Medicines  which  increase  perspiration. 

35.  What  are  "  sudorifics  ?  " 

Medicines  which  induce  copious  perspiration. 

36.  What  are  "  expectorants  ?  " 

Medicines  which  excite  secretory  action  in  the  air-passages. 

37.  What  are  "  emmenagogues  ?  " 

Medicines  Avhich  are  regarded  as  having  the  power  of  inducing 
or  increasing  the  menstrual  discharges. 

38.  What  are  "  siala2;oo;ues  ?  " 

Medicines  which  induce  an  increased  flow  of  saliva. 

39'.   What  are  "  errhines  ?  " 

Medicines  which  induce  increased  nasal  discharges. 

40.  What  is  a  "seton  ?  " 

A  strip  of  linen,  or  piece  of  thread,  which,  by  means  of  a  seton- 
needle,  is  passed  through  a  fold  of  the  skin  and  allowed  to  remain. 
By  occasional  moving  of  this,  -counter-irritation  is  maintained. 

41.  What  are  "  epispastics  ? 

Applications  to  the  exterior  of  the  body  which  produce  redness, 
usually  pain,  and  an  eifusion  of  serum,  thus  separating  the 
epiderm  from  the  "  cutis  vera"  and  presenting  what  is  called  a 
"  raw  surface  "  (commonly  called  "blisters  "  ). 

42.  What  are  "  alteratives  ?  " 

Medicines  which  are  accredited  with  effectino;  a  change  for  the 
better  through  the  general  function  of  nutrition. 

43.  How  is  blood  obtained,  and  how  is  it  replenished  ? 
Obtained  through  digestion  and  assimilation ;  replenished  by 

food. 


6  DENTAL    PATHOLOGY    AND    THERAPEUTICS. 

44.  What  is  the  "  pulse  ?  "     At  what  points  is  it  taken  ? 
Pulse  is  the  effect  of  the  heart-beat  upon  the  blood  in  the 

arteries.    Usually  taken  at  the  radial,  brachial,  temporal,  carotid 
or  femoral  artery,  or  from  over  the  heart  itself. 

45.  Name  the  varieties  of  pulse  and  their  opposites. 

"  Frequent  and  slow  "  (refer  to  the  number  of  pulsations  in  a 
minute);  "hard  and  soft"  (refer  to  compressibility — hardness 
indicates  general  strength  ;  softness  indicates  prostration) ;  "  quick 
and  sluggish  "  (quickness  indicates  slight  irritability  and  debility  ; 
sluggishness  indicates  exhausted  irritability  and  debility);  "full 
and  small  "  (refer  to  volume  of  pulsation  ;  unreliable  except  when 
taken  into  consideration  with  other  kinds  of  pulse) ;  "  strong  and 
weak  "  (strength  is  a  general  indication  of  health  ;  weakness,  of  an 
opposite  condition) ;  "  regular  and  irregular  "  (belong  to  nervous 
disorders  or  idiosyncrasies). 

46.  Give  the  normal  frequency  of  the  pulse  from  foetal  life  to 
old  age. 

Fostal  heart, 140  beats  per  miDute. 

At  birth, 130  "  "  " 

First  year, 110  "  "  " 

Second  year, 100  "  "  " 

Fifth  year, 90  "  "  " 

Tenth  year, 85  "  "  " 

Puberty, 80  "  "  " 

Adult, 75  "  " 

Old  age, 80  "  "  " 

47.  What  are  the  ordinarily  classified  constituents  of  the 
blood — the  relative  proportions  in  normal  blood  ? 

Eed  and  white  corpuscles,       . 140  parts. 

Fibrin, 3 

Albumen, 70 

Fatty  matters, .     . '   .         4 

Salts, 6 

Water, 777 

Total, 1000 

48.  What  is  the  division  of  the  blood  in  circulation  ? 
Red  and  white  corpuscles  and  liquor  sanguinis. 

49.  What  is  the  division  of  drawn  blood  ? 
"  Clot"  and  serum. 


MEMOEANDA. 


MEMORANDA. 


GENERAL    PRINCIPLES.  7 


50.  What  is  the  "clot?" 

The  red  and  white  corpuscles  suspended  in  meshes  of  fibrin. 

51.  What  is  serum  ? 

The  albumen,  salts  and  fatty  matters  of  the  blood  held  in  solu- 
tion by  the  Avater. 

52.  What  is  the  first  act  of  vitality  in  connection  with  the 
blood  ? 

Coagulation. 

53.  What  is  the  last  act  ? 
Coagulation. 

54.  What  constituent  of  the  blood  seems  nearest  allied  to  coag- 
ulation ? 

Fibrin. 

55.  What  are  the  three  great  peculiarities  of  clot  ? 

1st,  uniform  coagulation  with  little  contraction  (showing 
healthy  clot) ;  2d,  uniform  coagulation  with  marked  contraction 
and  plainly  "-cupped"  (indicative  of  angemia) ;  Sd,  tough,  con- 
tracted and  concaved,  with  "bufify  coat"  (occurring  in  general 
inflammatory  conditions). 

56.  What  is  meant  by  the  "  buffy  coat  ?  " 

The  peculiar  buff"-colored  film  upon  the  surface  of  the  "'  inflam- 
matory clot." 

57.  What  is  meant  by  "Angemia;"  "Spanasmia;"  "  Hyper- 
semia ;"  "  Plethora  ?  " 

Deficiency   of  red  corpuscles;   poor   blood;  abundance  of  red 
corpuscles;  fullness  of  blood-vessels. 
58.'  How  is  anaemia  divided? 
Into  "  Acute  "  and  "  Chronic." 

59.  What  is  the  cause  of  acute  anaemia  ? 
Direct  loss  of  blcod  by  hemorrhage. 

60.  What  are  the  symptoms  in  their  order  of  severity  ? 
Pallor;  coldness;  weak,  small  pulse;  muscular  debility;  gasp- 
ing; faintness  ;   complete  syncope;   death. 

61.  What  is  its  treatment? 

Remove  cause  by  stopping  hemorrhage ;  stimulate  respiration 
by  ammonia  or  electricity;  administer  tonics  to  give  strength, 
and  food  to  replenish  blood ;  give  perfect  rest. 


DENTAL    PATHOLOGY    AND    THERAPEUTICS. 


62.  How  is  electricity  applied  in  this  case  ? 

Place  the  ''  positive"  pole  at  the  nape  of  the  neck,  the  "nega- 
tive" at  the  ensiform  cartilage;  intermit  twelve  or  fifteen  times  a 
minute. 

63.  What  is  the  cause  of  chronic  anaemia  ? 

Loss  in  quantity  or  quality  of  blood,  due  to  long-continued  influ- 
ences. 

64.  What  is  the  treatment  for  chronic  an;\?mia  ? 

The  continued  administration  of  phosphatic  and  chalybeate 
tonics  and  bitters  (gentian,  quassia,  etc.),  moderate  exercise, 
journeying,  and  a  judicious  employment  of  time  as  to  occupation. 
enjoyment,  feeding  and  sleeping. 

65.  How  is  plethora  first  divided  ? 
■■'Sthenic"  and  ''Asthenic." 

66.  What  is  meant  by  sthenic  plethora  ? 

Excess  of  blood,  with  increased  irritability  and  tonicity,  com- 
bined with  a  tendency  towards  fevers  and  local  inflammations. 

67.  What  is  meant  by  asthenic  plethora ".' 

Excess  of  blood,  with  want  of  irritability  and  tonicity,  combined 
with  a  tendency  towards  systemic  depression. 

6S.  What  is  the  treatment  for  sthenic  plethora  ? 

Blood-letting,  actual  and  medicinal  sedation,  light  and  limited 
diet,  and  decided  exertion. 

69.  What  is  the  treatment  of  asthenic  plethora "' 

Tonic  medication,  moderate  drastic  purgation,  strengthening 
and  nourishing  diet,  and  regulated  moderate  exercise. 

70.  How  is  plethora  secondarily  divided  '.' 
General  and  local. 

71.  What  is  local  plethora  ': 
Excess  of  blood  in  a  part. 

72.  How  is  local  plethora  divided ".' 
'•Determination,"  "Congestion."  "Inflammation." 

73.  What  is  the  location  and  peculiarity  of  "  determina- 
tion? " 

Location — In  the  arteries  and  arterial  capillaries.  Peculiarity 
— Excess  of  blood,  with  motion  increased. 

74.  What  is  its  exciting  cause  ? 
Irritation  or  stimulation. 


MEMORANDA. 


MEMORANDA. 


GENERAL    PRINCIPLES.  9 

75.  What  are  its  symptoms  and  effects  ? 
Increased  sensation  and  nutrition  (hypertropliy). 

76.  What  are  the  four  means  for  treatment? 
"Depletion,"  "Derivation,"  "Relaxation,"  "Sedation." 
77.^  What  are  the  meanings  of  these  terms  ? 
"Depletion,"   actual   blood-letting;    "derivation,"   a  draining 

away  of  the  blood  to  a  distant  part  by  derivatives;  "relaxation," 
slight  general  or  systemic  weakening,  as  by  small  doses  of  nau- 
seants ;  "sedation,"  actual  local  or  systemic  depression  by 
sedatives. 

78.  What  is  the  location  and  peculiarity  of  "congestion?" 
Location — Veins  and  venous  capillaries.     Peculiarity — Excess 

of  blood,  with  motion  diminished. 

79.  What  are  its  symptoms  and  effects  ? 

Blueness;  purplish  color;  diminished  warmth  and  sensibility; 
followed  by  numbness,  coldness  and  painful  distention  in  the 
part ;   cessation  of  functional  action  ;  transudations. 

80.  What  are  its  four  means  for  treatment  ? 

Mechanical  (pressure  and  support) ;  astringents  or  stimulants  ; 
depletives  ;  rubefacients  or  sorbefacients. 

81.  What  are  the  locations  and  peculiarities  of  "true  inflam- 
mation ?  " 

Location — Arteries,  capillaries  and  veins..  Peculiarity — Ex- 
cess of  blood,  with  motion  partly  increased  and  partly  diminished. 

82.  What  are  its  signs  and  symptom  ? 

Signs — Redness,  heat  (?)  and  swelling.      Symptom — Pain. 

83.  Describe  the  relative  changes  of  white  and  red  corpuscles 
which  are  apparent,  microscopically,  in  inflammation. 

White  corpuscles  increase  in  number  and  begin  to  adhere  to 
the  walls  of  the  vessels  and  amass  in  the  capillaries,  thus  arrest- 
ing the  progress  of  the  red  disks.  Some  of  the  white  globules 
work  through  the  walls  of  the  vessels,  and  are  called  exudation 
corpuscles.     When  one  of  these  dies  it  becomes  a  pus  corpuscle. 

84.  Into  what  twtJ  classes  is  inflammation  divided? 
"Sthenic,"   "Circumscribed"  or  "Phlegmonous,"  and  "As- 
thenic," "Diffused"  or  "Erysipelatous." 

85.  What  are  the  three  varieties  of  duration  ? 
"  Acute,"   "  Subacute  "  and  "  Chronic." 


10  DENTAL    PATHOLOGY    AND    THERAPEUTICS. 

86.  What  is  the  diiference  between  the  "general  "  and  "den- 
tal" acceptation  of  these  terms? 

Greneral — Acute,  three  weeks.  Subacute,  between  three  and 
six  weeks.     Chronic,  more  than  six  weeks. 

Dental — Acute,  three  to  four  days.  Subacute,  four  to  seven 
days.      Chronic,  more  than  one  week. 

87.  What  are  the  two  classes  of  irritants,  or  exciting  causes? 
"Local  or  Direct;"  "  General  or  Indirect." 

88.  What  are  the  three  divisions  of  the  "local  or  direct" 
irritants,  or  exciting  causes  ?     Their  meanings  ? 

"Mechanical"  (such  as  blows  and  splinters);  "Chemical" 
(such  as  acids  and  escharotics) ;  "Vital"  (such  as  virus,  malarial 
poison  and  arsenic). 

89.  What  is  the  distinctive  difference  between  them  ? 
Mechanical  and  chemical  irritants  wound  or  destroy  both  living 

and  dead  tissues;  vital  irritants  act  on  living  tissues  only.     (See 
Arsenic.) 

90.  What  is  meant  by  "  reaction  ?  " 

The  recuperative  act  of  vitality  which  follows  depression. 

91.  What  are  the  results  of  congestion  and  inflammation  ? 
Effusions. 

92.  What  is  the  difference  between  congestive  and  inflammatory 
effusions? 

Congestive  effusions  are  non-organizable;  inflammatory  effu- 
sions are  organizable  in  degree. 

93.  What  are  the  varieties  of  inflammatory  effusions? 
Euplastic,  or  highly  organizable  (cicatricial  or  reparative  tissue); 

Cacoplastic,  or  less  organizable  (indurations,  etc.);   Aplastic,  or 
non-organizable  (curdy,  yellow  tubercles,  etc.). 

94.  What  are  the  terminations  of  inflammation  ? 
Resolution  or  Suppuration. 

95.  What  is  meant  by  resolution  ? 

Subsidence  of  inflammation,  more  or  less  absorption  of  effu- 
sions, and  return  to  comparative  normality. 

96.  What  is  the  treatment  to  endeavor  to  effect  resolution  ? 
The  use  of   such  "  antiphlogistics "  as  "stimulants,"  "seda- 
tives," "evacuants,"  "  sorbefacients,"  "  pressure,"  "friction,"  etc. 


MEMORANDA. 


MEMORANDA. 


GENERAL    PRINCIPLES,  11 

97.  What  is  meant  by  suppuration  ? 

The  breakinor  down  of  circumvallated  tissues,  which,  with 
"white"  and  "tissue"  corpuscles,  forms  pus. 

98.  What  is  the  treatment  to  eifect  this? 
Stimulation. 

99.  What  is  the  difference  in  degree  between  stimulation  to 
effect  resolution  and  stimulation  to  eifect  suppuration  ? 

To  effect  resolution,  stimulate  in  moderation  (as  can  be  comforta- 
bly endured) ;  for  suppuration,  stimulate  decidedly  (all  that  can 
be  endured). 

100.  What  is  the  present  theory  of  pus  corpuscles  ? 

They  arc  the  devitalized  "  white  corpuscles  "  and  "tissue  cor- 
puscles."    (See  83.) 

101.  What  is  meant  by  the  "pyogenic  membrane  ?  " 
The  dividing  line  between  living  tissue  and  pus. 

102.  Is  this  line  truly  a  membrane  ? 
No. 

10-3.  What  are  the  symptoms  of  suppuration? 

Diminution  of  heat,  pain,  irritation  and  vascular  excitement ; 
swelling  becomes  softened,  with  fluctuation  upon  tapping;  redness 
replaced  by  yellowish  or  mottled  color. 

104.  What  is  an  "  abscess  ?  "     What  is  a  "  fistula?  " 

A  circumscribed  cavity  containing  pus.  A  tract  leading  to  an 
abscess. 

105.  What  is  "  pointing  ?  "     What  is  an  "  ulcer  ? " 

The  tendency  of  pus  to  the  surface,  usually  indicated  by  a  pale 
spot.     A  pus-discharging  opening. 

106.  What  is  meant  by  "  Grangrene, "  "Mortification," 
"Sloughing,"  "Caries,"  "Necrosis,"  "Sequestrum,"  "Exfolia- 
tion ? ' ' 

"Gangrene,"  incipient  mortification;  "Mortification,"  death 
and  decomposition  of  the  soft  parts  before  sloughing ;  "  Slough- 
ing," the  natural  separation  and  throwing  off  of  soft  parts; 
"  Caries,"  ulceration  of  bone  ;  "  Necrosis,"  death  of  bone  :  "  Se- 
questrum," dead  bone;  "Exfoliation,"  the  throwing  off  of  dead 
bone  ;  also  applied  to  the  "  elongation  "  of  the  teeth. 

107.  What  is  the  systemic  effect  of  extensive  suppuration  ? 
Diminution  of  fever;  frequent,  weak  pulse ;  chills  and  sweats, 

with  flashes  of  heat ;  weakness ;  exhaustion  and  possibly  death. 


12  DENTAL    PATHOLOGY    AND    THERAPEUTICS. 

108.   What  is  meant  by  the  term  "  adynamic  ?  " 
Debilitated  vitality. 


DECIDUOUS   TEETH. 

109.  How  is  a  tooth  anatomically  divided  ? 

Crown  (that  normally  outside  the  gum)  ;  neck  (that  at  the  free 
edge  of  the  gum) ;  root  or  roots  (that  imbedded  in  the  process) ;  its 
end  is  called  the  apex. 

110.  How  is  a  tooth  physiologically  divided? 
Enamel,  dentine,  pulp  and  cementum. 

111.  What  is  the  first  grand  division  of  all  teeth  ? 
Upper  and  lower. 

112.  Name  the  faces  of  the  teeth. 

Mesial,  .  .  toward  the  central  line. 

Distal,  .  .  away  from  the  central  line. 

Labial,  .  .  toward  the  lips,  from  cusjjid  to  cuspid  inclusive. 

Buccal,  .  .  toward  cheek,  from  first  bicuspid  to  wisdom. 

Palatal  superior  jaw,  -i 

T  •         ^  ■   s-    •       •         ^  toward  the  hard  palate  or  tongue. 

Lingual  inferior  jaw,  j  r  o 

Cutting  edge,     ....     pertaining  to  incisors. 

Cusp, "         "  cuspids. 

Articulating,     ....  "         "  bicuspids  and  molars. 

113.  What  are  the  various  functions  of  the  dental  pulp  ? 

A  means  of  nutrient  supply,  sensation,  preservation  of  trans- 
lucency  and  vital  resistance. 

114.  What  is  the  pericementum  ? 

A  vascular  membrane  between  the  cementum  and  the  walls  of 
the  alveolus.     It  nourishes  the  cementum. 

115.  What  is  the  order  of  eruption  of  the  "  deciduous  "  teeth  ? 

<-,  T  '  f  lower,     5  to    7  months. 

Ckntral  Ixcisoks, ■{  ' 

I  upper,    7  "     8 

T  T  f  lower,    8  '"'     9 

Latekal  Incisoks, ^  ' 

\  upper,    9  "  10 

FIRST  Molars, |  lower,  11  ''  12 

I  upper,  13       14 

^  .,  (  lower,  17  "  18 

Canines  or  Cispid,      .     .     .     .     <^  ' 

I  upper,  19  "  20 

Second  Molars,    . 23  "  30 


MEMORANDA. 


MEMORANDA. 


DECIDUOUS   TEETH.  13 


116.  What  are  some  of  the  exceptions  to  the  general  rule? 
Some  are  born  with  a  few  teeth  erupted.     The  lateral  incisors 

vary  as  to  period  of  eruption.  Occasionally  adults  are  edentulous 
from  birth. 

117.  To  what  phase  of  dentition  is  infantile  mortality  largely 
due  '.' 

Pathological  dentition. 

118.  What  are  the  three  divisions  of  pathological  dentition  ? 
1st,  moderate  in  severity,   shoAving  local   signs  and    first  six 

general  symptoms ;  2d,  decided  in  severity,  showing  in  addition 
the  next  four  general  symptoms;  3d,  dangerous' in  severity, 
having  in  addition  the  three  final  symptoms — congestion  of  brain, 
convulsions  and  emaciation. 

119.  Where  is  the  finger  to  be  introduced  in  the  mouth  of  an 
infant  less  than  ten  months  old '.' 

In  the   corner  of  the  mouth,  to  avoid  giving  pain,  no   teeth 
being  in  process  of  eruption  there. 

120.  Where,  if  more  than  ten  months  old  ? 

At  the  front  of  the  mouth,  the  incisors  having  erupted  and  the 
first  molars  being  in  process  of  eruption. 

121.  What  are  the  general  symptoms  of  pathological  dentition  ? 
Loss  of  appetite,  peevish  fretfulness,  tossing  restlessness,  actual 

wakefulness,  feverish  thirst,  painful  paroxysms,  continuous  suffer- 
ing, bowels  loose  or  constipated,  exhaustion,  tendency  toward 
congestion  of  brain,  congestion  of  brain,  convulsions  and  emacia- 
tion . 

122.  How  may  pathological  dentition,  dangerous  in  severity, 
terminate  ? 

It  may  even  terminate  in  death. 

123.  What  are  the  usual  local  signs  of  abnormal  dentition  ? 
Redness  and  swelling  ;  followed  by  whiteness  of  gums  ;  decided 

flow  of  saliva  ("drooling");  desire  to  suck  thumb  or  fingers; 
biting  the  ring  or  spoon  with  determination ;  alternately  taking 
and  refusing  the  breast ;  desiring  upright  position  (to  counteract 
flow  of  blood). 

124.  What  are  the  exceptions  to  this  ? 
When  some  or  all  of  these  sisrns  are  absent. 


14  DENTAL    PATHOLOGY    AND    THERAPEUTICS. 

125.  What  is  the  first  local  remedy  for  pathological  dentition  ? 
Lancing. 

126.  What  is  the  relative  resistance  between  normal  and 
cicatricial  tissue  ? 

Cicatricial  tissue  is  the  weaker,  because  of  its  secondary  forma- 
tion. 

127.  What  is  the  best  instrument  with  which  to  perform  the 
operation  of  lancing  ? 

A  narrow-bladed,  curved  bistoury,  wrapped  with  muslin, 
leaving  exposed  a  quarter  of  an  inch  of  the  point. 

128.  How  are  the  lower  incisors  to  be  lanced  ? 
Parallel  with  and  inside  the  cutting  edges  of  the  teeth. 

129.  How  are  the  upper  incisors  to  be  lanced  ? 
Parallel  with  and  outside  the  cutting  edges  of  the  teeth. 

130.  Why  this  precaution  to  lance  outside  or  inside  of  the 
incisor  teeth  ? 

In  order  that  the  lower  teeth  shall  erupt  so  as  to  occlude  inside 
the  upper. 

131.  How  are  lower  first,  lower  second  and  upper  second 
molars  to  be  lanced  ? 

Crucially,  with  the  X-incision  from  the  disto-lingual  cusp  to 
the  mesio-buccal  cusp,  and  from  the  disto-buccal  cusp  to  the 
mesio-lingual  cusp. 

132.  How  are  upper  first  molars  to  be  lanced  ?     Why  ? 
Crucially,  with  the  plus  (+)  incision  from  the  lingual  to  the 

buccal  aspect,  and  from  the  distal  to  the  mesial.     Because  the 
cuts  then  incise  the  gum  over  the  cusps. 

133.  How  are  cuspids  to  be  lanced? 
Similar  to  incisors  at  first. 

134.  What  is  the  treatment  in  pathological  dentition  after  the 
cusps  of  cuspids  are  erupted  ? 

Cut  the  ring  of  gum  at  two  or  four  points. 

135.  What  is  the  most  thorough  method  of  lancing  molars  in 
extreme  cases  ? 

Taking  off  a  block  of  gum. 

136.  In  performing  this  operation,  what  instruments  are  neces- 
sary ? 

Bistoury,  tenaculum  and  decidedly-curved  scissors. 


MEMORANDA. 


MEMORANDA. 


DECIDUOUS   TEETH.  15 


137.  Which  cuts  should  be  made  first  ?     Which  afterwards  ? 

First  the  lingual  cut,  disto-mesially ;  afterwards  the  buccal  cut; 
then  the  mesial  cross  cut.  Piercing  the  gum  block  with  tenaculum 
from  beneath  up.  the  distal  cross  cut  should  be  made  with  scissors. 
•  138.  What  are  the  immediate  dangers  from  lancincr? 

Injuring  the  enamel  ;  cutting  the  lips,  gums,  cheek  or  tongue, 
either  from  slipping  of  the  instrument  or  sudden  movement  of 
the  child. 

139.  How  are  these  to  be  guarded  against  ? 

Wrapping  blade  of  bistoury  with  muslin  (see  127) ;  properly 
finger-guarding  the  surroundings  ;  properly  securing  child  ;  care 
in  lancing  ;  anticipating  sudden  starts. 

140.  What  is  the  method  of  securing  child  ? 

For  lower  teeth  have  infant's  head  lying,  face  upward,  on  assist- 
ant's left  thigh  (operator  also  sitting) ;  child's  hands  crossed  and 
held  on  abdomen  by  right  hand ;  legs  held  by  right  arm  :  head 
held  and  eyes  covered  by  left  hand.  For  upper  teeth  reverse 
head  to  right  thigh. 

141.  How  should  the  child  be  placed  as  to  light? 

For  upper  jaw,  feet  towards  light ;  for  lower  jaw,  head  towards 
light. 

112.   What  is  the  subsequent  danger  from  lancing  ? 

Hemorrhage. 

143.  Which  is  the  most  dangerous  form  of  hemorrhage  ? 

Slow,  oozing,  atonic  hemorrhage. 

141.   How  is  this  dangerous ".' 

Through  the  blood  being  swallowed,  thus  remaining  unnoticed. 

145.  How  is  hemorrhage  controlled  ■.' 

By  giving  the  breast  or  ring ;  by  applying  accurate  local 
medication,  as  dental  iodine,  alcohol,  tincture  of  chenopodium 
album  or  erigeron  canadensis,  or  other  styptics  \  giving  the 
chenopodium  or  erigeron  internally  (see  medicaments) ;  placing 
patient  in  erect  position ;  hot  water  to  feet. 

146.  What  periods  of  babyhood  is  the  most  fraught  with  danger 
from  difficult  dentition  ?    Why? 

The  second  summer.  Because  then  winter-born  children  cut 
their  cuspids  and  summer-born  children  their  second  molars. 
The  hot  weather  aggravates  the  pain  of  eruption. 


16  DENTAL    PATHOLOGY    AND    THERAPEUTICS. 

147.  What  are  the  indications  for  extraction  of  the  deciduous 
teeth  ? 

When  the  inferior  permanent  oral  teeth  present  outside  the 
arch ;  when  the  superior  permanent  oral  teeth  erupt  inside  the 
arch  and  behind  the  deciduous ;  and  when,  in  conjunction  with 
frail  and  weakened  constitutions,  complications  are  liable  to  arise 
from  necrosed  and  exfoliating  deciduous  teeth.  As  a  rule,  it  is 
better  that  deciduous  teeth  should  remain  until  the  proper  absorp- 
tion of  their  roots  is  indicated  by  loosened  crowns. 

148.  If  deciduous  molars  are  extracted  between  the  ages  of 
five  and  seven  years,  what  injury  may  be  inflicted? 

The  developing  bicuspids  may  be  injured  mechanically,  inas- 
much as  the  roots  of  the  deciduous  molars  are  but  partially 
absorbed  and  envelop  approximately  the  developing  crowns  of 
the  bicuspids. 


PERMANENT  TEETH. 

149.  What  is  the  order  of  eruption  of  the  permanent  teeth? 

First  molars, from  51  to    7  years. 

Central  incisors, "  6  "    8  " 

Lateral  incisors, "  7  "    9  " 

First  bicuspids, "  9  "  10  " 

Second  bicuspids, "  10  "  11  " 

Lower  canines, "  10  "  12  " 

Second  molars, "  12  "  14  " 

Upper  canines, "  13  "  15 

Wisdom, "  17  "45  " 

Lower  teeth,  as  a  rule,  precede  the  upper  by  a  few  months. 

150.  What  is  the  peculiarity  of  pathological  eruption  of  upper 
wisdom  teeth  ?     Its  remedy  ? 

Presenting  buccally  and  growing  into  the  cheek.     Remedy — 
Grinding  off  cusps  or  extraction. 

151.  Which  are  generally  the  most  difficult  of  the  permanent 
teeth  in  pathological  eruption  ? 

Lower  wisdom  teeth. 


MEMORANDA. 


MEMORANDA. 


PERMANENT    TEETH.  17 


152.  What  are  the  symptoms,  in  their  order  of  severity,  of 
pathological  eruption  of  the  lower  Avisdom  teeth  ? 

Absence  of  wisdom  tooth ;  long  before  ready  for  lancing,  pecul- 
iar, deep-seated  pain  ;  pain  sprangling  in  front  of  ear  and  down 
neck ;  difficulty  of  opening  mouth  and  of  mastication ;  diminu- 
tion or  exacerbation  of  pain,  devoid  of  periodicity ;  localization  of 
pain  in  gum ;  swelling  of  gum  till  bitten  upon  and  wounded  by 
upper  molars  ;  high  inflammation  of  gum  ;  contiguous  parts  swol- 
len ;  tenderness  externally  on  pressure :  enunciation  and  deglu- 
tition difficult  to  impossible  ;  teeth  closed  ;  loss  of  appetite ;  con- 
finement to  bed  ;  complete  demoralization ;  nervous  irritability ; 
prostration,  with  quick  and  frequent  pulse ;  excessive  salivation ; 
fetid  breath  ;  puffy,  bloated  lips  ;  high  fever  ;  extensive  suppura- 
tion; pygemia  and  possibly  death. 

153.  What  is  the  treatment? 

In  the  first  stages  treatment  is  palliative.  Externally,  about 
the  seat  of  trouble — laudanum,  spirits  of  camphor,  strong  infusion 
of  hops,  mixture  of  laudanum,  tincture  of  aconite  and  chloroform 
(equal  parts),  aconitia  ointment  or  other  anodynes  which  do  not 
disfigure.  Internally — for  wakefulness,  5  or  10  grains  of  Dover's 
powder,  or  20  drops  of  laudanum,  or  20  to  30  drops  of  solution 
of.  bimeconate  of  morphia,  or  a  teaspoonful  of  solution  of  sul- 
phate of  morphia,  or  1  grain  of  opium  ;  when  pain  is  localized, 
lance,  making  the  X-incision  frequently  if  necessary  ;  if  this  is 
not  relieving,  insert  under  flap  a  small  portion  of  dental  acetate  of 
morj^hia  paste,  with  adjunct  of  cocaine  or  menthol,  on  cotton  ;  if 
gums  are  lacerated,  take  off"  a  block  of  gum ;  if  teeth  are  shut, 
wedge  open  with  soft  wood,  using  anodynes  or  electricity  exter- 
nally, or  a  general  aneesthetic  if  necessary. 

154.  How  should  the  electrodes  be  placed  ? 

Positive  over  otic  ganglion ;  negative  in  hand  of  patient. 

155.  What  are  the  indications  for  extraction  of  the  six-year 
molars  ? 

When  it  becomes  improbable,  at  eleven  years  of  age,  that  they 
will  be  preserved  for  any  length  of  time ;  when  pulp  is  devital- 
ized before  proper  formation  of  root  structure  ;  when  protrusion 
of  either  arch  or  other  irregularity  or  false  occlusion  may  be 
corrected  bv  their  removal. 


18  DENTAL    PATHOLOGY    AND    THERAPEUTICS. 

DENTAL  CARIES. 

156.  What  is  dental  caries  ? 

The  softening  and  decalcification  of  tooth  structure,  analogous 
to  ulceration  of  the  soft  parts. 

157.  What  is  the  first  cause  ? 

A  non-cognizable  systemic  influence,  under  which  the  non- 
essential portions  of  the  economy  are  sacrificed  for  the  conserva- 
tion of  the  essentials. 

158.  What  are  the  two  divisions  of  the  predispiosing  causes  of 
caries  ? 

General  and  Local. 

159.  What  are  the  four  divisions  of  general  predisposing  causes  ? 
Systemic,  Thermal,  Chemical  and  Parasitic. 

160.  Name  some  of  the  systemic  predisposing  causes. 
General   weakness,    typhoid  conditions,  struma,  rapid  growth 

and  depressing  influences,    such  as  enervating  modes  of  living, 
anxiety,  excessive  study,  undue  exertion,  pregnancy  and  nursing. 

161.  How  do  different  diseases  aff'ect  caries  ? 

Indirectly  only,  by  deranging  the  system  a.nd  lowering  the 
vitality ;  as  a  consequence,  teeth  of  low-grade  temperamental 
attributes  decay  most  easily. 

162.  How  does  struma  impress  caries  ? 

Struma,  in  the  lymphatic  temperaments,  predisposes  to  rapid 
and  painless  decay  ;  in  the  nervous  temperaments,  to  sensitive, 
liorny  caries. 

163.  What  are  the  three  divisions  of  local  predisposing  causes? 
Structure,  Form  and  Position. 

164.  Give  the  views  taught  in  regard  to  influences  dependent 
upon  structure,  form  and  position. 

Structure — In  proportion  as  teeth  are  of  dense  structure  do 
they  resist  decay. 

Form — Deep  sulci,  pits,  depressions  and  fissures,  though  not 
necessarily  productive  of  decay,  render  teeth  more  liable  to 
caries. 

Position — Crowded  or  irregular  dentures  seem  more  liable  to 
decay  from  mechanical  abrasion  and  from  increased  retention  of 
food  and  mucus. 


MEMORANDA. 


MEMORANDA. 


DENTAL    CARIES.  19 


PERIODS 

OF   DECAY 

(Appro: 

xiniately.) 

Ist- 

-  5  to    8  years. 

2d- 

-12  ' 

'  20      " 

3d- 

-30  ' 

'  35      " 

4th- 

-45  ' 

■'  50      " 

5th- 

-60  ' 

'  65      " 

6th- 

-70  ' 

'  75       " 

165.  What  is  meant  by  "  periodicity"  of  caries? 

Its  recurrence  at  certain  periods,  modified  by  temperament  and 
physical  condition. 

166.  Give  the  periods  of  decay  and  comparative  cessation 
from  decay. 

INTERVALS 
REASONS.  OF  EXEMPTION. 

(Approximately.) 
Systemic  effect  of  dis.  of  childhood.         8  to  12  years. 
Undue  growth.  20  "  30      " 

Family  and  business  cares.  35  "  45 

Approaching  latter  end  of  life.  j     gQ  yggj.g 

Beginning  of  dissolution.  65  to  70  years. 

Gradual  loosening  of  hold  upon  life.     75  "  80      " 
7th — 80  years,  at  which  time  rapid  senile  decay  may  supervene,  followed 
soon  after  by  death  of  patient. 

167.  What  is  taught  in  regard  to  the  effect  of  a  decaying 
tooth  upon  others? 

By  tending  to  localize  upon  itself  the  decay,  it  exempts  for  a 
time  those  less  liable  to  disintegration. 

168.  How  are  males  and  females  affected  in  different  degree  as 
regards  caries? 

Females  are  more  liable  to  caries,  because  of  indoor  life,  abnor- 
mal menstruation,  pregnancy  and  care  of  children.  Men  have 
more  fresh  air  and  exercise,  use  tobacco,  and,  when  free  from 
excesses,  are  less  likely  to  develop  caries. 

169.  How  does  tobacco-chewing  prevent  caries  ? 

By  acting  as  a  sialagogue,  thus  bathing  the  teeth  in  the  alka- 
line saliva. 

170.  What  theory  of  caries  is  taught  ? 
"Mechanico-Chemico-Vital,"  with  "Parasitic"  concomitants. 

171.  What  is  the  prophylactic  treatment  of  caries? 

1st,  systemic  treatment,  according  to  indications ;  2d,  using  at 
night  Castile  or  carbolic  soap,  solution  of  bicarbonate  of  soda  or 
lime  water,  Avith  a  soft  brush ;  brushing  hard  on  the  articulating 
faces  of  teeth  and  lightly  from  gum  down  on  inner  and  outer 
faces ;  dipping  finger  in  chalk  and  rubbing  into  interstices  of 
lower  buccal  teeth. 


20  DENTAL    PATHOLOGY    AND    THERAPEUTICS. 

172.  For  what  result  is  the  use  of  these  relied  upon? 
Castile  soap  is  cleansing  and  antacid ;  carbolic   acid  soap  is 

cleansing  and  antiseptic  (it  should  be  used  to  make  a  lather,  which 
in  turn  should  be  rinsed  through  the  spaces  between  the  teeth), 
and  is  by  far  the  best  local  prophylactic.  The  chalk  corrects  the 
acid  condition  of  the  mouth  which  supervenes  toward  morning ; 
lime  water  and  bicarbonate  of  soda  are  antacids. 

173.  What  is  taught  in  regard  to  pulverized  pumice? 

It  is  excellent  for  cleansing  and  brightening  teeth  and  does 
not  injure  the  enamel. 

174.  What  is  the  relative  liability  of  teeth  to  decay? 
1.  Lower  first  molar. 


2.  Upper  first  molar. 

3.  Lower  second  molar. 

4.  Upper  second  molar. 

5.  Upper  lateral  incisor. 

6.  Upper  second  bicuspid. 

7.  Upper  central  incisor. 

8.  Upper  first  bicuspid. 


9.  Lower  second  bicuspid. 

10.  Lower  third  molar. 

11.  Upper  third  molar. 

12.  Upper  cuspid. 

13.  Lower  first  bicuspid. 

14.  Lower  lateral  incisor. 

15.  Lower  central  incisor. 

16.  Lower  cuspid. 


175.  Of  what  practical  importance  is  the  knowledge  of  this? 
From  the  general  stand-points  of  saving  teeth,  clasping  plates 

or  correcting  irregularities,  it  is  a  safe  guide  to  the  saving  of  the 
best  teeth. 

176.  How  is  methodic  examination  conducted? 
Beginning  at  any  back  upper  tooth,  carefully  examine  every 

surface  of  each  tooth  in  regular  order,  finishing  on  lower  teeth. 

177.  Name  the  positions  liable  to  decay  on  each  tooth. 

The  mesial  and  distal  faces  of  all  teeth;  the  sulci  of  molars 
and  bicuspids ;  the  basilar  pits  of  incisors  and  canines ;  buccal 
faces  and  cervical  margins  of  molars  and  bicuspids ;  occasionally 
the  labial  and  lingual  surfaces  of  teeth, 

178.  What  is  needed  for  a  thorough  examination? 

Mouth  mirror,  spring  and  flexible  probes,  ligating  thread  or 
floss  silk,  and  wedges. 

179.  What  purpose  does  thread  or  silk  subserve? 

When  passed  between  teeth  it  indicates,  by  fraying,  a  rough- 
ened surface  of  enamel. 

180.  How  should  teeth  be  wedged  ? 

By  gently  introducing  a  flock  of  cotton  or  thin  wedge  of  soft 
pine  between  the  teeth.     This  should  be  repeated  several  times, 


MEMOEANDA. 


MEMORANDA. 


DENTAL    CARIES.  21 


until  the  teeth  are  nicely  separated.  A  thin  piece  of  India  rub- 
ber passed  between  teeth,  or  strong  thread  tied  between  teeth, 
may  be  useful  where  wedges  are  hard  to  start.  When  gum  is  to 
be  pressed  away,  oil  of  cloves  or  oil  of  cinnamon  should  be  placed 
on  the  cotton.  Sandarac  varnish  touched  to  cotton  wedge  holds 
it  in  place.  Jarvis's  or  Perry's  separators  are  useful  adjuncts  in 
making  examinations. 

ODONTALGIA. 

181.  What  is  Odontalgia  (toothache)? 
Pain  within  or  about  a  tooth  or  teeth. 

182.  What  is  the  first  cause  of  odontalgia? 
Sensitive  Dentine. 

SENSITIVE  DENTINE. 

183.  What  are  the  four  primary  divisions  under  which  sensi- 
tive dentine  is  discussed  ? 

1st,  Cases  with  no  perceptible  cavities  of  decay ;  2d,  Superficial 
Caries;    3d,  Simple  Caries;    4th,  Deep-seated  Caries. 

184.  What  are  the  symptoms  of  sensitive  dentine? 

Uneasy  sensations,  which  may  be  located  about  the  teeth,  jaws, 
cheeks,  eyes,  nose,  or  even  lips ;  position  of  cause  of  trouble  not 
positively  located  unless  touched ;  aggravation  from  contact  of 
salts,  sweets  and  sours  generally ;  from  hot  and  cold  applications 
frequently ;  from  touch  markedly — especially  from  finger-nail 
and  metallic  touch. 

185.  What  is  the  special  diagnostic  of  sensitive  dentine? 
Pain  upon  touch  ;    cessation  of  pain  upon  removal  of  contact. 

186.  When  examininsi;  for  sensitive  dentine  what  should  be 
especially  remembered  ? 

To  locate  each  place  when  examined,  as  the  sensitivity  is  fre- 
quently temporarily  obtunded  by  a  single  touch. 

.   CASES  WITH  NO  PERCEPTIBLE  CA  VITIES  OF  DECA  Y. 

187.  What  are  the  locations  for  these? 

1st,  at  the  necks  of  teeth;  sometimes  denuded,  sometimes  not; 
2d,  in  sulci;  3d,  upon  the  cusps,  cutting  edges  and  smooth  artic- 
ulating faces  of  teeth. 


22  DENTAL    PATHOLOGY   AND    THEEAPEUTICS. 

188.  What  is  their  appearance? 

Sometimes  imperceptible ;  either  hard,  smooth  and  polished, 
or  slightly  soft  under  touch  of  excavator ;  sometimes  discolored ; 
unaltered  in  contour,  or  more  or  less  sharply  concave,  as  though 
worn  by  brush,  but  not  always  due  to  this. 

189.  What  are  the  systemic  considerations  in  regard  to  acid 
vegetables,  condiments  and  medicines  ? 

They  induce  a  hyperacid  condition  of  the  stomach,  and  a  con- 
sequent hyperacidity  of  the  fluids  of  the  mouth,  causing  sensitive 
dentine,  setting  the  teeth  on  edge,  increasing  the  tendency  to 
decay,  and  producing  general  soreness  of  the  teeth. 

190.  What  is  the  systemic  treatment  ? 

1st,  forbid  indulgence  in  acid  fruits  and  the  like  for  a  few  days 
or  weeks,  according  to  the  severity  of  the  case;  2d,  correct 
hyperacidity  of  stomach  by  a  half  grain  to  two  grains  of  bicar- 
bonate of  soda  (or  a  quarter  grain  of  carbonate  of  ammonia)  in 
a  tablespoonful  of  water,  three  or  four  times  daily.  Give  the 
ammonia,  if  a  diffusible  stimulant  would  bedesirable.  When  the 
trouble  is  but  slight,  fruits,  etc.,  may  be  indulged  in  if  medicine 
be  used  continuously  to  counteract  the  hyperacidity. 

191.  What  are  the  applications  to  be  made  by  patients  ? 
Lime  water,  bicarbonate  of  soda,  prepared  chalk,  phenol  sodique 

(diluted),  aqua  ammonia  (diluted),  Castile  and  carbolic  acid  soaps. 

192.  What  severe  complications  pertain  to  sensitive  dentine 
aside  from  toothache  ? 

Facial  neuralgic  complications,  including  otalgia  and  ophthal- 
malgia. 

193.  What  is  the  cure  for  these  ? 
Remove  the  cause. 

■SUPERFICIAL  CARIES. 

194.  What  is  taught  in  regard  to  removal  of  superficial  caries 
in  teeth  proportionately  liable  to  become  carious  ? 

Superficial  caries  is  that  form  of  decay  which  admits  of  easy 
removal  by  files,  burs,  disks  or  chisels.  In  teeth  liable  to  become 
carious,  it  should  be  left  until  its  progress  indicates  the  intro- 
duction of  a  filling. 


MIIMORANDA. 


MEMORANDA, 


DENTAL    CARIES.  23 


195.  What  is  the  treatment  of  sensitive  dentine  in  this  con- 
nection ? 

The  same  as  in  simple  caries. 

SIMPLE  CARIES. 

196.  What  is  simple  caries  ? 

That  depth  of  cavity  which  first  requires  a  filling  material. 

197.  What  is  deep-seated  caries  ? 

Cavities  of  such  depth  as  render  irritation  of  the  pulp  liable 
during  medicating,  excavating  or  filling,  or  as  the  result  of  the 
operation. 

198.  What  is  the  first  remedy  for  sensitiveness  in  cavities  of 
simple  caries  ?     Why  advantageous  ? 

Dryness.  It  obtunds  sensibility,  as  dryness  of  the  tongue 
interferes  with  taste. 

199.  What  is  the  second  remedy  ? 

Rapid  cutting  with  sharp  excavators  or  burs. 

200.  What  is  the  rationale  of  this  ? 

The  suddenness  of  the  infliction  modifies  response. 

201.  What  is  the  proper  method  of  doing  this  ?     Why  ? 

Cut  from  within  outward,  or  bur  slight  undercut  at  the  bot- 
tom and  remove  the  periphery  afterward.  By  these  means  the 
organic  filaments  are  severed,  and  cannot  conduct  sensation  from 
the  outer  portions  to  the  pulp. 

202.  In  engine  work,  what  is  the  advantage  of  "motor"  power 
over  foot  power  ? 

Foot  power  is  surging  ;    "  motor  "  power  gives  steadiness. 

203.  Topical  Applications.  What  are  the  four  class  divisions 
of  these  medicaments  ? 

1st,  those  which  do  not  endanger  the  vitality  of  the  dental  pulp  ; 
2d,  those  which  may  possibly  endanger  the  pulp;  3d,  those 
which  are  liable  to  endanger  the  pulp  ;  4th,  that  which  is  dan- 
gerous to  the  pulp. 

204.  First.  Name  the  remedies  Avhich  do  not  endanger  the 
pulp. 

Prepared  chalk,  bicarbonate  of  soda,  oil  of  cloves,  eugenol, 
aqua  ammonia  fortior,  tannin  Nos.  1  and  2,  solution  of  chloral 
hydrate,   nitric   acid   (because  never  used  except  in   superficial 


24  DENTAL    PATHOLOGY    AND    THERAPEUTICS. 

sensitive    dentine),    dental    tincture   of    aconite,    menthol    and, 
muriate  of  cocaine. 

205.  Where  are  chalk  and  bicarbonate   of  soda  to  be  used  ? 
In  cavities  where  moisture  cannot  be  excluded ;    they  require 

moisture  to  produce  eifect. 

206.  Where  should  ammonia  be  used?     The  objections  to  its 


use 


In  dry  cavities,  guarding  the  air-passages.  Objections — Its 
pungent  odor,  irritant  effect  on  soft  tissues,  and  its  liability  to 
weaken  with  age. 

207.  Where  is  nitric  acid  efficacious  ? 

In  dry  cavities  of  hard  teeth,  accurately  applied  to  sentient 
point  on  a  gold  probe,  guarding  the  surrounding  tissues ;  it 
eats  out  the  cavity ;  should  be  neutralized  with  bicarbonate  of 
soda. 

208.  How  should  cocaine  be  used  ? 

In  crystal  form  only,  by  placing  a  minute  quantity  into  the 
cavity,  which  is  slightly  moistened  with  oil  of  cloves.  Solutions 
are  of  little  avail. 

209.  How  are  oil  of  cloves  and  eugenol  to  be  used  ? 

In  sensitive  cavities,  when  teeth  require  wedging  ;  placed  on 
the  cotton  wedge,  they  also  obtund  the  gum  while  pressing  aside. 

210.  Second.  Name  the  remedies  which  may  possibly  endan- 
ger the  pulp. 

In  deep-seated  caries — Creasote  and  carbolic  acid  (idiosyn- 
cratically),  carbonate  of  potassium,  caustic  potash  and  chloride 
of  zinc.     (See  Medicaments.) 

211.  Third.  Name  the  remedies  which  are  liable  to  injure  the 
pulp. 

Chromic  acid,  phosphoric  acid  and  ethylate  of  sodium. 

212.  What  is  taught  of  phosphoric  acid? 

It  should  not  be  used,  owing  to  its  inferred  devitalizing  action 
upon  the  pulp. 

213.  Why  is  chloride  of  zinc  called  a  "  polychrest?  " 
Because  of  its  wide  range  of  medicinal  application. 

214.  What  is  the  range  of  medicinal  application  of  chloride  of 
zinc? 

Detergent,  tonic,  astringent,  stimulant,  irritant  and  escharotic. 


MEMORANDA. 


MEMORANDA. 


DENTAL    CARIES.  25 


215.  What  is  the  proper  form  in  which  to  use  chloride  of  zinc 
as  an  obtundent  of  sensitive  dentine  ?     Why  ? 

Deliquesced.    Because   no   action  Avill   take  place  unless   deli- 
quesced, and  further  dilution  renders  it  irritant  instead  of  escharotic. 

216.  What    should    be    the    condition     of    the   cavity    when 
applied  ? 

As  dry  as  possible,  to  produce  the  greatest  effect. 

217.  What   is  the  method   of   preparing   chloride   of  zinc  for 
dental  use  ? 

Refer  to  Medicaments. 

218.  What  is  the  taste  of  chloride  of  zinc  ? 
Sweetish-bitter,  metallic,  astringent  taste. 

219.  What  is  the  method  of  applying  chloride  of  zinc  ? 
From  a  probe,  pointed  stick,  pellet  of  cotton  or  bibulous  paper, 

or  by  oxychloride  filling. 

220.  What    treatment    should    precede    the    chloride    of   zinc 
application  ? 

Systematic  consecutive  obtunding.     (See  252.) 

221.  What  are  the  usual    sensations    from  chloride   of    zinc 
applications  ? 

Painful  sensations. 

■222.  What  is  the  peculiarity  of  the  pain  ? 
Cold,  steadily  increasing  and  steadily  diminishing  pain. , 

223.  How  long  should  the  pain  continue  ? 
From  three  to  ten  or  fifteen  minutes. 

224.  What  should  be  the  characteristic  of  the  pain  ? 
Steady,  full,  round,  bearable. 

225.  What  kind  of  pain  may  supervene  ? 
Throbbing,  pulsating,  jumping  pain. 

226.  What  does  this  signify,  and  how  is  it  treated  ? 
However  slight,  it  signifies  pulp  irritation.     It  is  to  be  treated 

by  syringing  cavity  with  tepid  water  and  applying  oil  of  cloves, 
phenol  sodique,  tincture  of  benzoin,  eugenol  or  Jamaica  dog- 
wood. 

227.  What  are  the  points  in  regard  to  excavating  after  chloride 
of  zinc  applications  ? 

Begin  on  cessation  of  pain    and  excavate   only   that   dentine 
which  has  been  obtunded. 


26  DENTAL    PATHOLOGY    AND    THERA'PEUTICS. 

228.  What    care    must   be    taken  in  repeated  applications  of 
chloride  of  zinc  ? 

The  fact  of  pulp  approach  must  be  considered  and  care  taken 
not  to  irritate  it. 

229.  What  is  the  after-preparation  of  a   cavity   in   which  the 
dentine  has  been  obtunded  by  chloride  of  zinc  ? 

Neutralize    by    washing    cavity    with    tepid    water,  then    dry 
thoroughly,  moisten   dentine    with   oil   of  cloves,  and  dry  again. 

230.  How  is   the   application  of  carbonate   of  potassium  pre- 
pared for  dental  use  ? 

See  Medicaments. 

231.  What  is  the  method  of  applying  it  ? 

Trom  a  probe,  shar23-pointed  stick  or  pellet  of  cotton. 

232.  What  is  its  effect  ?     What  are  the  symptoms  ? 

It  obtunds  sensitivity.     Symptoms — Like  those  produced  by 
chloride  of  zinc,  but  much  less  severe. 

233.  How  is  it  neutralized  ? 
By  oil  of  cloves. 

234.  What  is  taught  regarding  it  ? 

It  is  a  safe  and  ordinarily  reliable  remedy. 

235.  What  are  the  characteristics  of  chromic  acid  ? 

Its  form  is  that  of  brilliant  crimson-red   crystals.     It  is  a  deli- 
quescent salt. 

236.  In  what  form  should  chromic  acid  be  used  as  an  obtundent? 
Deliquesced. 

237.  In  what  manner  should  one  guard  against  danger  ? 
Never  rely  upon  the  "  rubber-dam  "  guard,  as  the  acid  is  liable 

to  get  beneath  it ;  have  cavity  as  dry  as  possible  without  it ;  use 
chromic  acid  only  in  easy  or  accessible  cavities  in  hard  teeth, 
frequently  neutralizing  with  dry  chalk  or  bicarbonate  of  soda. 

238.  Why? 

Because  it  is  a  very  dangerous  and  uncontrollable  remedy,  and 
is  only  indicated  in  extreme  cases. 

239.  What  are  the  symptoms  accompanying  its  use  ? 
Perfect  quiet  for  a  time,  which  may  result  in  death  of  the  pulp. 

240.  What  is  the  indication  for  the  use  of  chromic  acid  ? 
When  chloride  of  zinc  fails  to  produce  other  than  a  persistent, 

disagreeable  pain. 


MEMORANDA. 


MEMORANDA. 


DENTAL    CARIES.  27 


241.  What  of  the  employment  of  chromic  acid  in  difficult 
places  ? 

It  should  never  be  used  in  such  places. 

1^42.  What  is  the  after-treatment  of  cavity  ? 

It  is  to  be  neutralized  by  syringing  thoroughly  with  tepid 
water,  made  alkaline  with  bicarbonate  of  soda ;  the  cavity  is  then 
treated  as  in  chloride  of  zinc  applications. 

243.  What  dangers  are  liable  from  chromic  acid  and  ethylate 
of  sodium  other  than  danger  to  pulps  ? 

They  are  liable  to  produce  unmanageable  ulcerations  and 
sloughing  sores. 

244.  What  is  taught  of  ethylate  of  sodium  ? 
It  is  an  obsolete  remedy. 

245.  Fourth.  That  which  is  dangerous  to  pulps.  Give  the 
various  names  of  this  medicament. 

Arsenic,  white  oxide  of  arsenic,  arsenious  acid,  ratsbane. 
(See  44(3.) 

246.  What  is  cobalt  ?     To  what  is  its  obtunding  power  due  ? 
A  brittle,  reddish-gray  metal;  magnetic;  slowly  oxidizes  in  the 

air.     Occurs  in  combination  with  arsenic,  to  which  it  owes  its 
obtunding  power. 

247.  What  is  taught  in  regard  to  the  use  of  arsenious  acid  or 
cobalt  for  obtunding  sensitivity  of  dentine? 

It  should  never  be  used,  as  sooner  or  later  it  will  probably 
devitalize  the  pulp. 

248.  What  is  taught  in  regard  to  the  use  of  arsenious  acid  or 
cobalt  in  very  small  quantities,  and  for  limited  periods  of  time,  to 
insure  safety  ? 

If  used  at  all,  it  is  liable  to  cause  the  death  of  the  pulp. 

249.  What  are  the  materials  deemed  best  as  pulp-protectors 
against  such  medicaments  as  may  possibly  or  are  liable  to  endan- 
ger the  pulp  ? 

Temporary  stopping,  capping  varnishes. 

250.  How  is  temporary  stopping  applied  ? 

Warmed  and  pressed  into  a  wafer  of  desired  size,  picked  up 
with  ^a  warm  probe,  softened  and  placed  in  position,  and  the 
edges  sealed  with  a  warm  burnisher.  It  makes  an  impervious  and 
non-irritating  protector. 


28  DENTAL    PATHOLOGY    AND    THERAPEUTICS. 

251.  What  is  taught  regarding  zinc  phosphates  in  this  connec- 
tion ? 

As  their  ultimate  action  upon  the  pulp  is  as  yet  undetermined, 
it  is  better  not  to  use  them.     (See  212.) 

252.  What  are  the  systematic  consecutive  applications  for  the 
obtunding  of  sensitive  dentine  in  deep-seated  caries  ? 

Prepared  chalk,  \ 

Bicarbonate  of  soda,        >  Antacids. 
Aqua  ammonia  fortior,  J 

1.  Oil  of  cloves  or  eugenol. 

2.  Pressure,  with  burnishers,  on  sides  of  cavity. 

3.  Muriate  of  cocaine  (crystals).     (See  208.) 

This  failing,  dry  cavity  and  nicely  adapt  wafer  of  temporary  stop- 
ping for  pulp  protection.    This  remains  permanently.    (See  250.) 
Then  apply — 

4.  Tannin  No.  1,  \  p,  . 

5.  Tannin  No.  2,  I     ^'^''^■ 

6.  Carbolic  acid. 

7.  Carbonate  of  potassium  (drier). 

8.  Chloride  of  zinc  (escharotic). 

If  carbonate  of  potassium  seem  indicated,  begin  with  oil  of  cloves 
and  medicate  consecutively  to  carbonate  of  potassium  ;  if 
chloride  of  zinc  seem  indicated,  begin  with  carbolic  acid. 

253.  How  long  need  each  application  remain  in  the  cavity  ? 
Only  till  the  succeeding  one  is  ready  for  application. 

254.  When  other  means  fail,  what  three  local  means  may  be 
resorted  td  ? 

Heat,  cold,  electricity. 

255.  What  are  the  various  forms  of  heat  ? 
Hot  air,  galvanic  cautery,  thermo-cautere. 

256.  What  is  the  galvanic  cautery  ? 

A  platinum-wire  loop,  heated  by  a  current  of  electricity.  It 
should  be  rapidly  but  deliberately  touched  to  the  sensitive  por- 
tions. 

257.  What  are  the  various  forms  of  cold  ? 

Cold  air,  ice,  spraying  of  sulphuric  ether,  rhigolene  or  other 
volatile  liquids  on  the  tissue  to  be  obtunded. 

258.  How  is  electricity  used  ? 

By  means  of  the  "  Dental  Helix." 


MEMOEANDA. 


MEMORANDA. 


DENTAL    CARIES.  29 


259.  What  three  important  considerations  govern  the  applica- 
tion of  a  current  ? 

1st,  it  must  be  an  interrupted  primary  induction  current, 
because  not  rasping;  2d,  the  current  must  range  from  imper- 
ceptible to  that  of  sufficient  strength;  3d,  the  increase  and 
decrease  of  current  must  be  under  control  of  the  patient. 

260.  How  should  the  poles  of  a  dental  helix  be  placed  for  the 
excavation  of  sensitive  dentine? 

By  means  of  dental  electrode.  For  front  teeth — Small  sponge  ; 
negative  on  gum  at  tooth ;  positive  in  hand.  For  back  teeth — 
Large  sponge;   negative  on  cheek  or  jaw ;  positive  in  hand. 

261.  What  unpleasant  results  may  follow  electricity  ? 
May  cause  tonic  spasms  or  partial  paralysis. 

262.  If  unpleasant  sequel?e  follow  electricity,  how  are  they  to 
be  removed  ? 

Reverse  the  current. 

263.  What  medicaments  are  recommended  for  general  or  sys- 
temic effect  in  modifying  sensitivity  of  dentine  ? 

Sulphate  of  morphia,  opium,  laudanum  or  paregoric ;  and,  when 
opium  is  idiosyncratically  contra-indicated,  solution  of  bimeconate 
of  morphia,  in  alternation  with  asafoetida.  A  two-grain  asa- 
foetida  pill  (sugar  coated)  or  a  teaspoonful  of  syrup  of  lactucarium 
at  tea-time,  with  ten  to  twenty  drops  of  the  solution  of  bimeconate 
of  morphia  at  bed- time,  and  a  repetition  of  the  bimeconate  of 
morphia  solution  an  hour  previous  to  the  operation,  induces  a 
quieted  state  of  the  nervous  system,  modifying  sensitivity. 

264.  What  is  the  last  resort  ? 
"To  produce  general  insensibility. 

265.  How  is  this  effected  ? 

By  partial  anaesthesia,  or  by  hypodermic  injections  of  the  solu- 
tion of  sulphate  of  morphia  and  atropia. 

266.  What  is  taught  of  the  safety  of  anaesthesia  ? 

The  agent  must  be  thoroughly  understood.  No  agent  which 
in  a  minute  or  two  can  produce  total  exemption  from  pain  during 
a  severe  operation  can  be  regarded  as  perfectly  safe. 

DEEP-SEATED  CARIES. 

267.  What  is  deep-seated  caries  ? 
See  197. 


30  DENTAL    PATHOLOGY   AND    THERAPEUTICS. 


268.  What  is  the  general  condition  of  cavities  in  deep-seated 
decay  ? 

They  are  full  of  decomposing  material,  and  more  or  less  broken- 
down  tooth  structure. 

269.  How  may  more  injury  than  benefit  be  inflicted  ? 
By  removing  too  much  of  the  decalcified  dentine. 

270.  What  is  the  twofold  action  of  cavity  contents  ? 

1st,  protective — protecting  pulp  from  thermal  changes ;  2d, 
detrimental — destructive  to  tooth  tissue  and  irritating  to  pulp 
from  putrescence. 

271.  What  is  the  first  step  in  preparation? 

Gently  stir  debris  with  a  probe,  and  syringe  with  tepid  water ; 
dry  with  bibulous  paper  or  absorbent  cotton ;  if  indicated,  break 
down  enamel  edges  for  free  ingress. 

272.  What  is  to  be  especially  avoided  ? 

Any  irritation,  shock  or  compression  of  the  pulp. 

273.  How  should  such  cavities  be  syringed  ? 

Gently,  with  tepid  water  (decidedly  warm,  but  not  hot),  direct- 
ing the  stream  away  from  pulp  and  toward  the  cavity  walls. 
The  syringe  should  be  filled  and  emptied  several  times  before 
using,  to  preclude  the  presence  of  cold  water  in  the  jet. 

274.  Into  what  three  classes  are  such  washed  and  dried 
cavities  divided  ? 

1st,  those  containing  white  decay;  2d,  yellow,  gray,  brown 
and  black  decay ;  3d,  decay  of  horny  consistency. 

275.  Give  some  peculiarities  concomitant  with  soft  white 
decay. 

Cavity  edges  soft,  easily  broken  down  ;  large  fractures  liable, 
with  but  slight  force ;  decayed  material  short-grained  and  homo- 
geneous ;  permits  of  easy  removal  and  ready  ingress  to  danger- 
ous proximity  to  pulj).  Excavate  carefully ;  usually  little  or  no 
sensation  or  warning  of  approach  to  pulp. 

276.  Give  peculiarities  concomitant  with  yellowish,  brownish 
and  blackish  decay. 

External  edges  of  varied  strength,  all  reasonably  strong;  rea- 
sonable amount  of  warning  sensitivity ;  marked  change  of  color, 
even  over  pulp  horns.  , 


MEMORANDA. 


MEMORANDA. 


DENTAL    CARIES.  31 


277.  Give  peculiarities  concomitant  with  decay  of  "horny" 
consistency.     What  caution  should  be  observed  ? 

The  decay  is  long-grained  and  tough.  Cut  with  keen  instru- 
ments from  within  out,  to  avoid  exposing  the  pulp,  as  the  grain 
runs  deep. 

278.  What  is  taught  relative  to  conservation  of  this  decalcified 
dentine  ? 

It  is  the  best  known  pulp-capping;  hence  should  be  judiciously 
conserved,  that  it  may  recalcify. 

279.  What  portions  should  be  conserved? 

All  that  does  not  interfere  Avith  the  integrity  of  the  filling. 

280.  What  governs  its  medication  ? 

Decalcification  being  due  mainly  to  action  of  acids,  medication 
should  be:  1st,  alkaline,  to  neutralize  acidity;  2d,  soothing  and 
pulp-protecting;  3d,  avoidance  of  coagulating,  irritating,  escha- 
rotic  or  disorganizing  medicaments,  such  as  carbolic  acid,  creasote, 
chloride  of  zinc  and  strong  acids. 

281.  What  considerations  govern  the  choice  of  filling  materials  ? 
1st,  position  of    cavity  ;    2d,  physical  characteristics  of  tooth 

structure;  3d,  strength  or  weakness  of  cavity  walls;  4th,  thick- 
ness or  tenuity  of  dentine  covering  pulp. 

282.  What  materials  are  suggested  for  filling  such  teeth  ? 
Intermediates    of    plaster    of    Paris,    oxysulphate,   temporary 

stopping  or  arnica  plaster ;  linings  of  varnish,  oxychloride, 
oxyphosphate  and  zinc  phosphate ;  fillings  of  gutta-percha,  oxy- 
chloride, zinc  phosphates,  amalgam  and  tin,  or  gold  with  linings. 

283.  What  governs  the  introduction  of  such  fillings  ? 
Avoidance  of  pain  from  pressure,  gentle  or  lateral  packing  of 

material,  or  arching  over  pulp,  increasing  solidity  towards  surface. 

284.  Besides  danger  from  immediate  trouble,  what  dangers  are 
pros2:)ective  f 

Irritation  of  pulp  from  thermal  changes,  prevention  of  exu- 
dation from  pulp,  and  devitalization  of  dentine  between  the  pulp 
and  filling  material. 

285.  How  are  pulps  covered  with  dentine  sometimes  exposed 
after  filling  such  cavities  ? 

By  death  and  disintegration  of  the  film  of  dentine  between  the 
pulp  and  filling  material. 


DENTAL    PATHOLOGY    AND    THERAPEUTICS. 


286.  How  are  pulps  naturally  protected  ? 

By  "  recalcification,"  "  tubular  consolidation  "  or  deposition  of 
"secondary  dentine." 

287.  What  is  meant  by  recalcification  ? 

The  replacement  by  the  pulp  of  the  inorganic  matter  of  the 
dentine.     (See  280.) 

288.  What  is  meant  by  tubular  consolidation  ? 

An  excessive  deposit  of  calcific  matter  in  the  dentinal  tubuli, 
between  the  pulp  and  the  external  irritant. 

289.  What  is  meant  by  deposition  of  secondary  dentine  ? 

A  formation  of  dentine  within  the  boundaries  of  the  physio- 
logical pulp  cavity. 

290.  What  is  the  second  cause  of  odontalgia  ? 
Irritation  of  the  dental  pulp  prior  to  exposure. 

291.  What  five  classes  of  irritants  are  spoken  of  under  this  head  ? 
Mechanical,  chemico-vital,  vitiated  fluids  of  the  mouth  (when 

notably  acid),  thermal  changes  and  infiltrations.     (See  354.) 

292.  Give  example  of  mechanical. 
Impacting  of  food  or  other  pressure. 

293.  Give  examples  of  chemico-vital. 
Decomposing  food  and  seeds. 

294.  What  is  the  sign  of  vitiated  fluids  of  the  mouth  ? 
Glairy  viscidity,   or  "spider-web"  appearance' of  the  saliva. 

295.  Which  teeth  are  most  liable  to  be  afiected  by  cold  air  ? 
The  upper  incisors  and  cuspids,  and  lower  incisors,  cuspids  and 

bicuspids. 

296.  Which  is  generally  most  irritating,  hot  or  cold?     Why? 
Cold.    Because  ice  water  at  a  temperature  60°  below  blood  heat 

(98°)  is  easily  borne  in  the  mouth,  while  liquids  40°  above 
blood  heat  can  scarcely  be  endured ;  it  follows  that  cold  can  cause 
more  deviation  from  the  normal  temperature  by  20°,  and  be  to 
that  extent  the  more  irritatina;. 

297.  What  infiltrations  are  irritating  ? 
Salt,  sweet  and  sour. 

298.  What  are  the  symptoms  of  pulp  irritation  in  such  cavities  ? 
Uneasy  sensations,  generally  positively  located  at  periods  of 

recognized  irritation ;  no  sharp,  paroxysmal  attacks  ;  no  increase 
of  pain  upon  pressure  on  tooth ;    no  throbbing. 


MEMORANDA. 


MEMORANDA. 


DENTAL    CARIES.  33 


■    299.   What  is  meant  by  "spontaneous"  pain? 

Pain  occurring  in  the  absence  of  any  tangible  irritant. 

300.  How  does  this  influence  prognosis  ? 

Unfavorably ;  the  abnormality  thus  indicated  is  rarely  combated 
successfully. 

301.  What  is  taught  in  this  connection  regarding  masses  of 
decayed  dentine  ? 

In  conservative  treatment  of  the  pulps  of  poor  teeth  it  is 
essential  that  the  largest  possible  amount  of  the  decalcified  organic 
mass  should  remain  in  protected  security. 

302.  What  pulp  considerations  are  referred  to  in  this  con- 
nection ? 

The  pulp  considerations  bearing  upon  the  future  value  of  this 
conserved  dentine  are :  The  comparative  normality  of  the  pulp, 
its  probable  and  possible  recuperative  power,  together  with  the 
temperamental  attributes  and  physical  condition  of  the  patient. 

303.  What  two  objects  are  gained  by  conservation  of  decayed 
living  dentine  ? 

1st,  the  prevention  of  exposure  and  undue  approach  to  pulp ; 
2d,  possession  of  an  organized  matrix,  which,  being  "protected," 
ma^  recalcify. 

■  304.  For    the    proper    preparation    of    a    cavity    containing 
"horny"  decay,  what  is  necessary? 

Dryness,  secured  by  napkins  or  rubber  dam. 

305.  What  may  follow^  dryness  and  be  caused  by  it  ? 
Pain. 

306.  What  is  the  best  application  for  the  relief  of  this  ? 
Oil  of  cloves. 

307.  Is  pulp  conservation  universal  under  such  treatment  ? 

In  a  vast  majority  of  cases  it  is  successful,  but  not  universally 
so.  Marked  adynamic  complication,  with  poor  and  non-recupera- 
tive temperaments,  together  with  local  and  systemic  influences, 
are  factors  which  produce  failures  in  this  direction. 

308.  What  are  the  indications  of  success  ? 

Gradual  establishment  of  comfort,  with  but  few  periods  of  unea- 
siness or  of  recognized  irritation. 


34  DENTAL    PATHOLOGY    AND    THERAPEUTICS. 

309.  What  are  the  indications  of  danger  ? 

Sensations  of  uneasiness  ;  occasional  thought  of  tooth,  accom- 
panied with  undefined  apprehension  of  trouble. 

310.  What  are  the  symptoms  of  failure? 

Increasing  response  to  heat ;  occasional  odontalgic  and  neu- 
ralgic pain ;  no  pain  at  first  on  pressure,  but  perhaps  pain  on 
tapping,  owing  to  concussion  of  pulp,  not  to  peridental  irritation ; 
no  sensation  of  elongation  of  tooth  ;  uneasiness  and  pain,  inter- 
mittent or  remittent,  according  to  degree  of  aggravation,  hut  not 
periodic  ;  sometimes  but  little  discomfort  while  pulp  quietly  dies, 
and  sometimes  such  toothache  as  calls  for  immediate  relief. 

311.  What  are  the  symptoms  accompanying  the  more  marked 
cases  ? 

Acute  response  to  hot  and  cold,  inducing  paroxysms  of  odon- 
talgia ;  tenderness  on  pressure  from  determination  of  blood,  with 
its  concomitant  hypergesthesia,  outside  of  apical  foramen. 

312.  What  is  the  notable  exception  to  these  symptoms? 
Congestion  of  the  bulbous  portion    of   the   pulp,  precluding 

i-esponse  to  heat  and  cold. 

313.  What  is  taught  of  "facial  neuralgia"  in  this  connection  ? 
This  gradual  death  of  the  pulp  may  produce  neuralgic  troubles 

of  almost  every  grade  of  intensity  and  duration,  intermittent  or 
remittent,  according  to  degree  of  aggravation,  but  not  periodic. 

314.  What  are  the  locations  of  the  neuralgic  pain  ? 

From  a  superior  incisor  or  cuspid,  below  the  eye  and  in  the 
cheek  and  upper  lip ;  from  a  superior  bicuspid  or  molar,  upward 
over  the  eye  and  into  the  ear  ;  from  lower  anterior  teeth,  decid- 
edly localized  about  the  chin  and  lower  lip ;  from  lower  molar, 
backward  to  the  eye,  down  the  neck ;  in  rare  cases  even  to  the 
arm  and  hand.  The  salivary  glands  also  appear  to  be  excited  to 
excessive  secretion. 

315.  What  are  the  possibilities  in  connection  with  congestion 
of  the  pulp  ? 

Absorption  of  effusions  and  re-establishment  of  normality  ; 
chronic  congestion  without  positive  trouble  for  an  indefinite 
period ;  active  or  passive  death,  and  putrescence  or  mummifica- 
tion, such  possibilities  being  controlled  by  age,  temperament  and 
physical  condition. 


MEMORANDA. 


MEMORANDA. 


DENTAL    CARIES.  35 


316.  What  is  the  summary  of  causes  of  irritation  in  deep- 
seated  caries  ? 

1st,  vitally,  by  irritating  and  escharotic  applications ;  2d, 
mechanically,  by  excavating  ;  3d,  by  pressure,  the  result  of  plug- 
ging ;  4th,  by  conduction  or  other  irritation  after  plugging. 

317.  What  is  the  summary  of  remedies  ? 

1st,  judicious  applications  and  proper  protection  ;  2d,  care  in 
excavating  and  accurate  knowledge  of  the  location  of  pulp  cavi- 
ties ;  3d,  by  using  lateral  pressure,  judicious  impacting  of  foil, 
the  interposition  of  a  solid  base  to  sustain  unavoidable  pressure, 
or  the  employment  of  plastic  filling  materials  ;  4th,  interposition 
of  non-conducting  or  porous  intermediate  material. 

318.  Name  some  intermediates. 

Temporary  stopping,  gutta-percha,  arnica  court-plaster,  adhe- 
sive plaster,  shred  tin,  crystal  gold,  sheet  lead,  tin  foil,  muslin 
dipped  in  camphor,  quill,  cork,  ivory. 

319.  How  is  arnica  court-plaster  prepared  for  use  ? 

A  piece  cut  to  proper  size  should  be  laid,  back  down,  in  a  drop 
of  water  for  fifteen  minutes,  and  the  application  gently  made,  first 
removing  excess  of  water  by  touching  back  of  the  plaster  to 
bibulous  paper. 

320.  What  are  recommended  as  non-conducting  and  supporting 
intermediates  in  deep  decay  ? 

1st,  metal  plate,  fitted,  warmed  and  placed  in  cavity,  with 
temporary  stopping  underneath,  adhering  both  to  it  and  to  the 
dentine ;  2d,  temporary  stopping,  covered  with  oxychloride  or 
zinc  phosphate,  which  can,  at  the  same  time,  subserve  a  purpose 
as  a  lining. 

321.  What  are  the  gradations  from  "deep  decay  "  to  exposure? 
1st,  very  deep  decay ;    2d,   nearly  exposed  pulp  ;    3d,  quite 

exposed  pulp. 

322.  Are  these  always  of  equal  import?     Why  ? 

No.  Because  "deep  decay"  in  the  nervo-lymphatic  tooth 
would  call  for  all  the  care  and  skill  required  in  an  "  almost 
exposed  "  pulp  of  a  nervo-sanguine  tooth,  and  the  comparatively 
simple  "nearness  of  decay  to  the  pulp"  in  the  bilio-lymphatic 
tooth  is  equivalent  to  "  absolute  exposure  "  in  the  bilio-sanguine. 
(See  33T.) 


36  DENTAL    PATHOLOGY    AND    THERAPEUTICS.       • 

323.  What  are  the  eight  controlling  influences  in  conservation 
of  pulps  ? 

Age,  temperament,  physical  condition,  sex,  occupation,  over- 
exertion (mental  or  physical),  place  of  residence  and  mode  of 
living,  thermal  and  barometric  changes. 

324.  To  what  times  of  life  does  "  age  "  refer  ? 

Youth,  maturity  and  old  age.  These  are  again  subdivided  into 
periods  of  decay  and  comparative  cessation  from  decay.   (See  166.) 

325.  What  is  "temperament  ?  " 

"  A  peculiar  state  of  the  constitution  depending  upon  the  rela- 
tive proportion  of  its  masses  and  the  relative  energy  of  its  differ- 
ent functions." — S.  R.  Wells. 

326.  Of  what  importance  is  a  knowledge  of  temperaments  to 
a  dentist  ? 

A  knowledge  of  the  temperament  is,  when  coupled  with  a 
knowledge  of  the  age,  physical  condition,  occupation  and  sur- 
roundings of  an  individual,  a  basis  upon  which  to  calculate  all 
treatment  of  the  teeth  and  to  prognose  all  probabilities  in 
connection  therewith.  In  dental  prosthesis  it  governs  the  sizes, 
shapes,  shades  and  relative  positions  of  artificial  teeth. 

327.  What  is  the  first  division  of  temperaments  ? 

Four  basal  temperaments — Bilious,  Sanguine,  Lymphatic  and 
Nervous. 

328.  What  is  the  second  division  of  twelve  "dual"  tempera- 
ments ? 

1st,  Sanguo-bilious,  Lymphatico-bilious,  Nervo-bilious ;  2d, 
Bilio-sanguine,  Lymphatico-sanguine,  Nervo-sanguine  ;  3d,  Bilio- 
Lymphatic,  Sanguo-lymphatic,  Nervo-lymphatic ;  4th,  Bilio- 
nervous,  Sanguo-nervous,  Lymphatico-nervous. 

329.  Into  what  two  classes  are  temperamental  attributes 
divided  ? 

Internal  and  External.     (See  330.) 


MEMORANDA. 


MEMORANDA. 


DENTAL    CARIES. 


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38*  DENTAL    PATHOLOGY   AND    THERAPEUTICS. 

331.  From  what  three  stand-points  are  the  internal  attributes 
considered  ? 

General  circulation,  innervation  and  nutrition. 

332.  What  is  the  grouping  of  temperaments  for  dental  study 
called  ? 

Dento-temperamental. 

333.  What  is  a  dental  temperament  ? 

A  binary  or  tertiary  temperament — i.  e.,  one  which  names 
last  the  prominent  characteristic  and  first  the  modifying  attribute. 
In  "bilio-sanguine,"  sanguine  is  predominant,  modified  by  bilious. 
A  still  slighter  modification  is  expressed,  as  in  lymphatico-bilio- 
sanguine,  or  nervo-lymphatico-bilio-sanguine. 

334.  Why  is  the  dual  system  adopted  in  this  classification? 

It  is  usually  sufficient;  modification  of  it  must  be  studied  from 
the  indications. 

335.  Name  the  four  classes  into  which  temperaments  are 
divided  dentally. 


1. — Bilio-sanguine. 

Sanguo-bilious. 
2. — Lymphatico-sanguine. 

Lymphatico-bilious. 

Nervo-bilious. 

Nervo-sanguine. 


3. — Sanguo-lymphatic. 

Bilio-nervous. 

Sanguo-nervous. 

Lymphatico-nervous. 
4. — Bilio-lymphatic. 

Nervo-lymphatic. 

336.  What  are  the  characteristics  of  each  class'i 

1st,  ''Excellent;"  2d,  "Good;"  3d,  "Doubtful  and  anx- 
ious;"  4th,  "Positively  bad." 

337.  If  sanguo-bilious  follows  bilio-sanguine,  why  does  not 
sanguo-lymphatic  follow  lymphatico-sanguine? 

It  will  be  seen  that  the  reliable,  hopeful  and  recuperative  base 
of  the  lymphatico-sanguine  becomes  merely  a  slightly  controlling 
influence  over  the  utterly  unreliable  and  non-recuperative  base  of 
the  sanguo-lymphatic,  while  the  bilious  and  sanguine  attributes, 
when  combined  with  each  other,  either  as  base  or  modifier,  form 
two  dental  temperaments  which  are  unsurpassed. 

338.  What  are  the  characteristics  of  each  dental  temperament? 
See  339. 


MEMORANDA. 


40 


DENTAL    PATHOLOGY    AND    THERAPEUTICS. 


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46  DENTAL    PATHOLOGY    AND    THERAPEUTICS. 

340.  In  what  manner  does  physical  condition  influence  pulp 
conservation  ? 

Grood  temperaments,  with  poor  physical  condition  (such  as 
typhoid  conditions),  respond  but  slowly  to  medication,  while  good 
physical  condition,  even  in  poor  temperaments,  assists  largely  in 
producing  satisfactory  results. 

341.  How  does  over-exertion  act  upon  it? 

Over-exertion  impairs  physical  condition.  Exertion  which 
produces  a  more  or  less  continuous  state  of  fatigue  will  be  more 
or  less  detrimental  to  the  recuperation  of  a  pulp. 

342.  Sex.     What  circumstances  in  the  male  act  adversely  ? 
Greater  exposure  and  more  violent  exertion  than  in  the  female. 
348.  What  in  the  female  ? 

Pregnancy,  abnormal  menses  and  other  uterine  complications. 
(See  168.) 

344.  In  what  manner  does  occupation  influence  it  ? 

By  causing  over-exertion  or  enforcing  positions  which  carry  the 
blood  to  the  head.  Sedentary  employment,  poor  ventilation, 
imperfect  drainage  (causing  noxious  gases),  changes  of  tempera- 
ture, the  mental  anxiety  connected  with  occupation,  or  anything 
which  lowers  the  general  vital  force,  diminishes  the  probability  of 
pulp  conservation. 

345.  How  does  mode  of  living  act,  beneficially  or  preju- 
dicially ? 

This  acts  upon  physical  condition  in  proportion  as  it  is  strength- 
ening or  weakening,  soothing  or  irritating,  luxurious  and  healthful 
or  penurious  and  unwholesome,  nutritious  or  a  mere  pandering  to 
the  appetite. 

346.  What  is  taught  regarding  the  influence  of  location  or 
place  of  residence? 

Residence  in  malarial  places  has  a  decidedly  adverse  influence 
upon  the  general  health,  consequently  upon  pulp  conservation. 
Pulps  capped  in  healthy  localities  often  give  serious  trouble  and 
sometimes  die  when  removed  to  unhealthy  places. 

347.  How  should  such  cases  be  treated  when  the  patient  is 
visiting  only? 

Unless  very  pronounced,  soothe  pulp  till  patient  can  return  to 
the  healthy  locality. 


MEMORANDA. 


MEMORANDA. 


DENTAL    CARIES.  47 


348.  What  constitutional  support  is  recommended  in  such  cases 
as  have  adynamic  complications  ? 

Mild  gentian  or  quassia,  boneset,  nitro-muriatic  acid  alone  or  in 
combination  with  antiperiodics. 

349.  What  is  taught  regarding  thermal  influences,  either 
local  or  general  ? 

Local  applications  of  hot  or  cold  shock  pulps  in  proportion  to 
loss  of  protecting  dentine,  unless  non-conducting  intermediates 
or  filling  materials  be  used.  Sudden  changes  of  warm  and  cool 
temperature  conduce  to  colds,  congestions,  fluxes  and  inflam- 
mations. These  changes,  together  with  continual  exposure  to 
heat  or  the  shock  of  cold  baths,  may  produce  systemic  effects 
adverse  to  conservation  of  pulps. 

350.  How  do  barometric  changes  influence  pulp  conservation? 
Barometric  changes  are,  as  a  rule,  exciting  and  may  cause  much 

irritation.  In  this  climate  March  and  November  are  unfavorable 
months  for  conservative  treatment,  because  of  frequent  and 
decided  thermometric  and  barometric  changes. 

351.  What  is  the  third  cause  of  odontalgia? 

Irritation  of  the  dental  pulp  from  almost  complete  or  complete 
exposure  and  from  dying  pulp. 

352.  What  are  the  symptoms  ? 

Paroxysmal  and  remittent  or  intermittent  pain,  but  not  peri- 
odic ;  not  always  positively  located ;  very  severe  during  parox- 
ysms; throbbing  or  jumping;  great  exacerbation  from  thermal, 
vital  or  mechanical  irritation  ;  greater  at  times,  generally  during 
the  night  or  while  in  recumbent  position ;  no  increase  of  pain 
from  pressure  upon  tooth,  but  sometimes  upon  tapping,  due  to 
concussion.     (See  310  to  315.) 

353.  What  does  periodicity  of  the  pain  indicate  ? 
Malarial  or  other  endemic  complications. 

354.  What  are  the  six  heads  under  which  liability  to  irritation 
prior  to  filling  are  discussed  ? 

1st,  infiltration  of  salt,  sweet  and  sour  condiments  (the  most 
usual) ;  2d,  direct  contact  with  foreign  bodies  ;  3d,  pressure  of 
foreign  material ;  4th,  thermal  irritation  from  even  slight  devia- 
tions of  temperature  ;  5th,  mechanical  irritation  during  excavating, 
etc. ;  6th,  medicinal  applications.     (See  395.) 


48  DENTAL    PATHOLOGY    AND    THERAPEUTICS. 

355.  What  is  the  first  and  most  important  knowledge  needed 
for  diagnosing  an  almost  exposed  or  exposed  pulp  ? 

Accurate  knowledge  of  location,  size  and  shape  of  pulp  cavity. 

356.  What  is  taught  in  regard  to  the  pulp  cavity  being  a 
miniature  of  the  crown  of  the  tooth  ? 

That  it  is  so  only  in  a  general  way,  not  sufficiently  so  for 
accurate  practice,  fine  cornua  being  found  in  blunt  cusps  and 
cornua  of  different  lengths  in  cusps  of  nearly  equal  length. 

357.  What  is  taught  in  regard  to  the  relative  position  of  the 
pulp  cavities  in  teeth  in  the  hand  and  teeth  in  the  mouth  ? 

The  position  of  teeth  in  the  jaw  is  never  that  upright  one 
given  in  diagrams  or  which  is  usual  in  manual  examinations.  In 
the  superior  teeth  the  crowns  slant  outwardly,  while  in  the  lower 
teeth  they  slant  inwardly.  These  positions  must  be  studied  in  the 
mouth  before  practical  application  of  this  knowledge  can  be  made. 

358.  What  four  considerations  obtain  in  relating  cavities  of 
decay  with  exposure  of  pulps? 

1st,  situation  of  cavity  of  decay  ;  2d,  depth  of  cavity ;  3d, 
direction  of  cavity  ;  4th,  character  of  caries. 

359.  What  is  taught  in  regard  to  depth  of  cavity  ? 

This  does  not  refer  to  actual  depth,  but  to  nearness  of  bottom 
of  cavity  to  the  pulp. 

360.  What  of  the  character  of  caries  ? 

In  proportion  as  the  decay  is  of  the  rapid  variety  is  exposure 
probable. 

361.  What  are  the  four  means  of  diagnosing  almost  exposed 
or  exposed  pulps  ? 

1st,  visual  test ;  2d,  pressure  test ;   3d,  thermal  test ;  4th,  taxis. 

362.  How  is  the  visual  test  made  ? 

Either  by  direct  observation  or  by  reflection  with  the  mouth- 
mirror,  the  cavity  being  properly  cleansed  and  dried. 

363.  Plow  should  the  mouth-mirror  be  prepared  ? 

Warmed  carefully  over  the  flame  of  a  spirit-lamp,  or  by  dipping 
into  warm  water,  or  by  resting  for  a  moment  flat  upon  the  tongue. 

364.  What  is  the  appearance  of  the  dentine  overlying  an 
almost  exposed  pulp  ? 

Varying  from  altered  shade  of  dentine  and  varied  pink  or  red, 
even  to  dark  shades  of  blue  or  brown. 


MEMORANDA. 


MEMORANDA. 


DENTAL    CARIES.  49 


365.  What  is  the  appearance  of  an  absolutely  exposed  pulp  ? 
The   peculiar    "orifice"    appearance   of  even  a  needle-point 

exposure  requires  to  be  seen   but  few  times   to   insure   ready 
recognition. 

366.  How  is  the  pressure  test  made  ? 

By  pressure  with  a  pellet  of  cotton  in  the  direction  of  the  sus- 
pected exposure. 

367.  How  is  pain  from  sensitive  dentine  to  be  distinguished 
from  pulp  irritation  ? 

The  former  stops  on  cessation  of  pressure,  and  is  usually  felt 
about  the  periphery  of  the  cavity ;  the  latter  usually  continues 
for  a  short  space  of  time  after  the  irritant  is  withdrawn,  and  is 
felt  in  the  location  of  the  pulp  cavity. 

368.  How  is  the  thermal  test  made? 

By  placing  one  drop  of  cold  water  against  the  side  of  the  cavity 
and  allowing  it  to  run  upon  the  pulp ;  if  no  response  is  given, 
more  cold  water  may  be  cautiously  injected. 

369.  How  is  "taxis"  performed? 

By  very  gently  and  cautiously  touching  the  pulp  with  an 
untempered  probe,  guarding  against  nod  of  patient  by  pressing 
the  thumb  of  left  hand  against  upper  teeth. 

370.  What  would  be  liable  to  produce  nod  of  patient  ? 
Affirmative  response  to  question  regarding  pain. 

371.  If  no  response  be  given  by  pulp  upon  taxis,  what  is  the 
indication  ? 

Death  of  at  least  the  bulbous  portion  of  the  pulp. 

372.  What  medicaments  are  recommended  for  the  soothing  of 
almost  exposed  or  exposed  pulps  ? 

Tincture  of  benzoin,  laudanum,  spirits  of  camphor,  phenol 
sodique,  oil  of  cloves,  oil  of  cinnamon,  fluid  extract  of  piscidia 
erythrina,  hydrate  of  chloral,  eugenol,  thymol,  oil  of  cajeput,  oil 
of  eucalyptus,  creasote  or  carbolic  acid  (only  when  intending  to 
devitalize),  acetate  of  morphia  paste,  menthol,  muriate  of  cocaine, 
dental  tincture  of  aconite,  iodoform  paste. 

PULF  CAPPING. 

373.  What  is  pulp  capping? 

The  placing  of  a  protection  for  the  conservation  of  an  exposed 
or  practically  exposed  pulp  requiring  more  than  an  intermediate. 


50  DENTAL    PATHOLOGY   AND    THERAPEUTICS. 

374.  What  are  the  first  considerations  ? 

Whether  indications  are  favorable  or  unfavorable  to  the  effort 
of  pulp  conservation. 

375.  What  are  taught  as  the  governing  influences  in  pulp 
conservation,  good  material  for  capping  and  proper  manipula- 
tion conceded  ? 

Condition  of  pulp,  temperament,  age  and  physical  condition 
decide  the  grade  of  help  to  be  afforded  to  a  pulp.     (See  339.) 

376.  What  are  the  seven  desirable  attributes  for  capping  mate- 
rial, named  in  their  order  of  importance  ? 

Non-conductivity,  non-irritating  quality,  porosity,  soothing  or 
healing  quality,  plasticity,  resisting  capability,  durability. 

377.  Of  what  importance  is  porosity  ? 

It  absorbs  the  serum  which  oozes  from  the  pulp,  even  through 
dentine.  It  is  imperatively  demanded  when  lymphatic  or 
adynamic  complications  exist. 

378.  What  is  the  advantage  of  plasticity  ?     Of  durability  ? 
Plasticity  enables  easy  placing,  with   subsequent  hardening, 

without  irritation  of  pulp.  Durability  gives  comparative  per- 
manency to  a  capper  in  case  of  confluent  decay  or  fracture  of 
tooth  substance. 

379.  Name  a  few  materials  which  are  used  as  pulp-cappers. 
Oxysulphate   of  zinc,    plaster   of   Paris,    oil   of  cloves   pad, 

hydrated  oxychloride  of  zinc,  varnishes,  solutions  of  gutta-percha, 
medicated  pastes  under  concave  plates  (Weston's  caps),  thin  lead 
plate,  tea-chest  lead. 

380.  What  is  taught  regarding  gutta-percha  as  a  capper  ? 

It  is  one  of  the  standard  applications ;  should  be  used  in 
chloroform  or  benzole  solutions,  either  dropped  upon  the  pulp  or 
applied  under  concave  plate.  It  possesses  all  the  qualities  except 
those  of  porosity  and  healing  quality. 

381.  What  is  taught  of  oxysulphate  of  zinc  ? 

It  is  an  excellent  capper,  and  is  reasonably  accredited  with 
therapeutic  as  well  as  protective  value. 

382.  What  is  taught  of  plaster  of  Paris  ? 

It  possesses  all  the  attributes  except  that  of  durability.  The 
cavity  should  be  filled  with  the  quick-setting  plaster  ;  when  hard, 
this  should  be  cut  out  to  desired  depth. 


MEMORANDA. 


MEMORANDA. 


DENTAL    CARIES.  51 


383.  How  is  the  oil  of  cloves  pad  made  ? 

By  making  a  paste  of  oxide  of  zinc  and  oil  of  cloves,  and 
applying  as  a  first  layer  under  oxychloride  of  zinc. 

384.  What  is  taught  of  oxychloride  of  zinc  ? 

That  its  claims  as  an  excellent  conserver  of  pulps  have  not 
been  positively  proven,  and  that  while  it  has  many  good  points, 
and  may  sometimes  produce  just  sufficient  irritation  of  pulp  to 
result  in  good,  yet  its  known  irritating  power  and  its  doubtful 
clinical  record  render  it  safer  to  reject  it  for  this  special  purpose. 

385.  Does  oxychloride  possess  the  power  of  mummifying  pulps 
which  die  under  it  ? 

It  does  not  possess  such  power,  though  pulps  may  mummify 
under  it. 

386.  What  is  taught  of  hydrated  oxychloride  of  zinc  as  a  capper? 
It  is  regarded  as  a  good  capper. 

387.  What  is  taught  of  the  zinc  phosphates  as  cappers  ? 
Their  use  in  this  connection  is  decidedly  questionable.     Though 

not  absolutely  so  proven,  the  phosphoric  acid  they  contain  is 
supposed  to  have  a  devitalizing  power  over  the  pulp.     (See  251.) 

388.  How  is  lead  plate  to  be  used? 

Cut  to  proper  size ;  with  handle  end  of  an  excavator  make  it 
concavo-convex ;  make  hole  in  centre  to  allow  for  escape  of  sur- 
plus medicament ;  fill  concavity  with  soothing  medicaments  and 
apply  over  point  of  exposure. 

389.  What  length  of  time  is  taught  as  "probationary"  prior 
to  deciding  whether  efforts  at  pulp  conservation  are  likely  to  be 
successful? 

From  six  months  to  a  year. 

390.  Is  this  length  of  time  universally  reliable? 

It  is  not ;  for  pulps  may  give  symptoms  of  failure  in  less  time 
and  may  not  do  so  for  years. 

391.  What  length  of  time  should  elapse  before  success  may  be 
pronounced  ? 

At  least  from  five  to  seven  years. 

392.  What  is  taught  regarding  teeth  the  pulps  of  which  die 
lingering  deaths? 

The  pathological  condition  induced  by  slow  death  of  the  pulp 
is  one  of  such  chronic  alteration  of  nutrition  as  to  render  liable, 


52  DENTAL    PATHOLOGY   AND    THERAPEUTICS. 

upon  slight  irritation,  serious  and  frequently  uncontrollable  peri- 
dental trouble,  resulting  in  comparatively  early  death  of  the 
peridentium,  necrosis  of  the  root  and  loss  of  the  tooth.  Quick 
devitalization  permits  of  a  more  perfect  return  to  normality. 
(See  618.) 

393.  What  is  taught  regarding  efforts  at  conservation  of  pulps  ? 
That  the  value  of  the  living  pulp  is  exceedingly  great,  giving 

to  its  tooth  almost  every  chance  of  future  permanent  usefulness, 
in  place  of  the  almost  positive  certainty  of  future  liability  to 
trouble,  eventuating  in  the  loss  of  the  tooth ;  therefore  it  is 
not  only  warrantable,  but  professionally  imperative,  that  every 
effort  should  be  made  for  the  preservation  of  pulp  vitality. 

394.  What  three  considerations  contra-indicate  efforts  at  pulp 
conservation  ? 

1st,  decidedly  marked  pulp  irritation,  evidenced  by  several 
severe  attacks  of  paroxysmal  pain,  in  connection  with  a  probable 
future  of  pain  without  possibility  of  relief;  2d,  in  cases  where 
systemic  condition  is  decidedly  adverse  to  probability  of  success, 
and  where  the  suffering  from  chronic  disease  is  such  that  additional 
pain  would  be  decidedly  detrimental ;  3d,  in  cases  where  imme- 
diate immunity  from  all  possibility  of  subsequent  suffering  is 
shown  to  be  a  necessity,  from  business  or  other  important  consid- 
erations. 

395.  What  are  the  external  causes  of  irritation  to  pulp  other 
than  the  six  already  mentioned  ?     (See  354.) 

Prevention  of  exudation  by  filling ;  loss  of  tooth  substance 
from  attrition  ;  fracture  of  tooth ;  disease  of  the  surrounding  parts. 

396.  What  is  the  internal  cause  ? 
Pulp  nodules. 

397.  What  are  the  five  considerations  in  connection  with  pulp 
irritation  from  disease  of  the  surrounding  parts  ? 

Salivary  calculus ;  tartar ;  looseness  of  tooth  ;  abscess  ;  atrophy 
or  absorption  of  either  gum,  alveolar  process  or  roots. 

398.  How  is  pulp  irritation  from  loss  of  tooth  substance  by 
attrition  distinguished  from  sensitive  dentine  ? 

Sensitive  dentine  causes  unlocalized  uneasiness,  which  does  not 
increase  to  paroxysms.  (See  184.)  The  irritated  pulp  gives  local- 
ized and  paroxysmal  pain.     (See  298  and  352.) 


MEMORANDA. 


MEMORANDA. 


DENTAL    CARIE8.  53 


399.  What  instrument  is  used  in  the  diagnosis  of  pulp  exposure 
in  cases  largely  abraded  ? 

A  probe,  blunted  in  order  to  avoid  plunging  through  the  thin 
covering  of  dentine. 

400.  What  is  usually  the  best  method  of  remedying  irritation 
of  the  pulp  from  loss  of  tooth  substance  ? 

The  grinding  off  of  the  occluding  tooth,  together  with  the 
building  up  of  articulating  fillings  upon  three  or  four  not  unduly 
worn  antagonizing  teeth,  in  order  to  preclude  or  retard  further 
abrasion. 

401.  What  condition  is  sometimes  found  analogous  to  a  loss  of 
tooth  substance  by  attrition  and  eventuating  in  the  same  symp- 
toms ? 

Marked  clean  cupping  occurring  on  the  cutting  edges,  cusps 
and  articulating  faces  of  the  teeth,  such  cavities  presenting  a 
smooth,  defined  and  clean  appearance. 

402.  To  Avhat  is  this  due  ? 

It  is  regarded  as  due  not  entirely  to  mastication,  but  to  be  a 
peculiar  phase  of  dental  caries,  which  disintegrates  the  dentine 
prior  to  the  action  of  mastication. 

403.  How  is  this  condition  treated  ? 

By  preparation  of  cavity  and  filling,  as  in  ordinary  decay. 

404.  Upon  what  four  causes  is  fracture  of  the  tooth  dependent? 
1st,  impingement  upon  hard  substances,  as  bonq,  shells,  shot  or 

candy;  2d,  impingement  upon  only  moderately  hard  substances, 
when  extensive  decay  has  left  frail  walls;  3d,  blows  or  falls;  4th 
(very  unusual),  congestion  of  pulp.  The  symptoms  of  this  are : 
Fullness  within  tooth,  rapidly  passing  into  extreme  tension  and 
pain,  or  into  tense  numbness  and  growing  uneasiness.  When  the 
fracture  occurs,  a  noise  like  a  pistol-shot  is  sometimes  heard  hy 
patient. 

ABSORPTION  OF  PERMANENT  ROOTS. 

405.  What  are  the  signs  and  symptoms  of  absorption  of  per- 
manent roots?     Its  treatment? 

Absence  of  discoloration  of  tooth ;  neuralgic  pain ;  tenderness 
of  cheek  to  pressure ;  pain  in  the  eye,  with  amaurotic  and  possi- 
bly circulatory  complications  (sometimes  suffused  cornea  and  con- 
junctiva) ;    decided  response  upon  tapping;    sometimes   pricking 


54  DENTAL    PATHOLOGY   AND    THERAPEUTICS. 

sensation  on  pressure  (from  spiculated  condition  of  root) ;  great 
pain  from  decided  hot  or  cold  applications ;  general  sense  of 
uneasiness  about  jaw,  directly  referable  to  the  tooth  ;  almost 
universally  undefinable,  hut  positive  conviction  on  the  part  of 
patient  that  removal  of  tooth  would  insure  relief.  Such  teeth  are 
dense  in  structure  and  very  firmly  set  in  their  sockets.  Treat- 
ment— Extraction. 

PULP  NODULES. 

406.  What  is  "nodular  calcification?  " 

The  formation  Avithin  the  pulp  of  granular,  lobular,  kidney- 
shaped  or  spicular  deposits  of  calcific  matter,  generally  confined  to 
body  of  pulp,  though  sometimes  found  in  the  canals.     (See  396.) 

407.  What  are  the  signs  and  symptoms  of  pulp  nodules  ? 
Continued  or  intermittent  pain,  commencing  without  known 

irritant,  and  rapidly  increasing  in  violence  until  unendurable ; 
no  periodicity,  unless  under  malarial  influence  systemically ; 
sometimes  slight  external  inflammation.,  but  generally  health  line 
is  normal ;  peculiar  sensitiveness  of  enamel  on  scratching  it ; 
exquisite  sensibility  of  dentine,  increasing  upon  drilling. 

408.  How  is  diagnosis  of  this  condition  made? 
By  differentiation. 

409.  In  making  diagnosis  of  pulp  nodules,  what  influence 
has  temperament  and  physical  condition  ? 

Pulp  nodules  are  usually  found  in  connection  with  good  physi- 
cal condition  and  high-grade  temperaments  of  sthenic  attributes. 

410.  What  is  the  method  pursued  in  devitalizing  such  pulps  ? 
Preliminary     treatment,    systemically — Asafoetida    pills    and 

solution  of  bimeconate  of  morphia.  Locally — Application,  by 
operator  only,  of  aconitia  ointment,  followed  by  veratria  ointment, 
if  indicated,  over  the  eyes,  upon  the  temples,  sides  of  nose  and 
upon  the  cheeks  (about  and  below  infra-orbital  foramen),  avoid- 
ing eyes ;  use  powerful  obtundents  for  the  hypersensitive  dentine, 
as  chloride  of  zinc,  chromic  acid,  arsenious  oxide  or  electricity ; 
approach  pulp  cautiously,  avoiding  irritation  ;  soothe  pulp  irrita- 
tion if  any ;  apply  arsenic ;  make  steady  advances  into  pulp 
canals,  with  least  possible  irritation,  using  in  them  combinations  of 
acetate  of  morphia  paste,  muriate  of  cocaine,  menthol  and  dental 


MEMORANDA. 


MEMOHANDA. 


DENTAL    CARIES.  55 


tincture  of  aconite,  in  conjunction  with  arsenious  oxide  ;  no  haste 
should  be  made ;  when  tooth  is  quiet,  allow  it  to  so  remain  for 
weeks  if  needs  be. 

411.  What  is  taught  in  regard  to  complete  extraction  in  cases 
of  pulp  nodules  and  absorption  of  permanent  roots  ? 

Every  portion  of  root  must  be  extracted,  else  little,  if  any,  relief 
will  be  aiforded. 

412.  What  is  the  method  of  extracting  such  roots  as  are  broken 
off? 

Fissure-drill  around  root,  using  cocaine  applications  or  dental 
helix  as  obtundent,  and  lift  out  with  thumb-forceps. 

413.  What  is  "phantom  odontalgia?" 

A  pain  which  recurs  at  intervals  after  extraction,  resembling 
the  pain  experienced  previous  to  extraction.  It  is  caused  by 
extraction  of  tooth  during  a  period  of  intense  irritation  of  external 
filament  of  nerve  leading  to  pulp. 

414.  What  is  the  best  method  of  preventing  this  ? 

To  absolutely  quiet  pulp  for  twenty-four  hours  and  then  extract ; 
then  make  application  of  acetate  of  morphia  paste  (with  cocaine 
and  menthol)  in  alveolus,  precluding  irritation  by  guard  if  neces- 
sary. 

FUNGOUS  GUM  AND  FUNGOUS  PULP. 

415.  What  is    fungous  gum  and  fungous  pulp  ?  . 

A  benignant  hypertrophied  condition  of  gum  or  pulp. 

416.  How  is  a  fungous  growth  of  gum  within  a  tooth  diagnosed 
from  that  of  fungous  pulp  ? 

This  cannot  be  done  except  by  treatment. 

417.  What  is  the  treatment? 

Soothing,  constringing,  sorbefacient.  Gradually  press  aside 
with  cotton  medicated  with  acetate  of  morphia  or  dental  iodine 
until  diagnosis  can  be  made  as  to  whether  the  growth  is  an 
ingrowing  gum  fungus  or  a  pulp  fungus. 

418.  What  indicates  fungous  pulp  ? 

The  fact  that  the  growth  does  not  arise  from  a  cavity  or  per- 
foration, but  from  a  pulp  canal. 

419.  What  is  taught  regarding  color  as  a  diagnostic  sign  ? 
Fungous  gum  and  fungous  pulp  are  alike  in  color,  from  light 

pink  to  dark  purple ;  color  is,  therefore,  not  a  diagnostic. 


56  DENTAL    PATHOLOGY    AND    THERAPEUTICS. 

420.  What  is  taught  regarding  sensitivity  as  a  diagnostic 
symptom  ? 

Fungous  gums  and  fungous  pulps  may  be  either  exquisitely 
sensitive  or  devoid  of  sensitivity ;  therefore  sensitivity  is  no  diag- 
nostic. 

421.  What  is  taught  of  applying  arsenic  at  once  ? 

Never  apply  at  once ;  because,  if  the  fungous  growth  is  hyper- 
trophied  gum,  the  arsenical  impress  will  be  given  to  the  tissues 
outside  of  the  tooth. 

422.  What  is  a  perforation  ? 

A  cavity,  excavation  or  drill-hole  perforating  the  cementum. 

423.  How  is  it  treated  ? 

Moisten  cotton-wool  with  oil  of  cloves  or  fluid  cosmoline  and 
press  gently  into  cavity ;  impinge  upon  outside  tissue  just  suffi- 
ciently to  permit  accurate  contour  healing ;  this  accomplished, 
gently  dry  cavity  with  absorbent  cotton,  place  smooth  pieces  of 
low-heat  white  gutta-percha  (warmed)  over  orifice,  and  secure  in 
position.  A  drill-hole  should  be  enlarged  inwardly  to  a  conical 
shape  for  obvious  reasons.  (See  Plastics  and  Plastic  Fillings, 
p.  138.) 


COMPLICATED  CARIES. 

424.  What  is  complicated  caries  ? 

That  stage  of  decay  which  requires  for  its  proper  treatment 
pulp  cavity  and  canal  work. 

425.  Is  a  pulpless  tooth  a  dead  tooth  ? 

No ;  because  the  cementum  and  pericementum  are  still  vital ; 
the  enamel  and  dentine  only  are  devoid  of  nourishment.    (See  114.) 

426.  Why  is  the  dentine  dead  ? 

Because  the  pulp  is  the  source  of  its  nutrition,  and  the  pulp  is 
dead. 

427.  What,  then,  constitutes  a  dead  tooth  ? 

One  the  pulp  and  pericementum  of  which  no  longer  perform 
their  functions. 

428.  What  is  the  natural  result  of  such  a  condition  ? 
Exfoliation. 


MEMORANDA. 


MEMORANDA. 


COMPLICATED    CARIES.  57 


429.  Is  a  dead  tooth  ever  tolerated  in  the  jaw  ? 
Occasionally  ;  in  such  cases  it  may  usually  be  left  until  indica- 
tions point  to  its  removal. 

430.  What  are  such  indications  ? 

Unbearable  annoyance,  irremediable  elongation,  unsightly  dis- 
coloration, injurious  pus  formation,  caries  or  necrosis  of  contigu- 
ous parts. 

431.  What  natural  results  may  follow  the  death  of  a  pulp  ? 
Loss  of  vital  resistance,  translucency,  nutrition   and  sensation 

of  dentine.     (See  113.) 

432.  What  untoward  results  may  follow  the  death  of  a  pulp  ? 
Discoloration  of  tooth,  periodontitis,  alveolar  abscess,  necrosis 

of  root  and  caries,  or  necrosis  of  surrounding  process,  with  their 
probable  attendant  neuralgic  complications.     (See  714.) 

433.  What  is  the  cause  of  loss  of  translucency  ? 

A  disorganization  of  the  contents  of  the  dentinal  tubuli. 

434.  What  is  the  cause  of  discoloration  ? 

Infiltration  of  tooth  tissue  by  external  or  internal  discoloring 
material. 

435.  Is  it  possible  to  remove  this  discoloration  ? 

Not  always  ;  sometimes  by  excavating  the  discolored  dentine,  or 
whitening  with  prepared  chalk  and  lining  with  oxychloride  or 
oxyphosphate  of  zinc,  a  reasonable  restoration  of  color  may  be 
made ;  but  frequently,  with  the  use  of  all  means,  discoloration 
may  recur. 

436.  What  two  remedies  present  to  this  condition  of  final 
discoloration  ? 

1st,  pivoting  or  crowning ;  2d,  extraction  and  replacement  by 
artificial  substitute. 

437.  What  is  taught  of  bleaching  ? 

It  is  of  doubtful  value,  the  darkness  frequently  returning 
worse  than  before. 

438.  Is  a  tooth  ever  better  when  pulpless  than  when  fully 
vital ? 

Yes ;  the  value  of  a  pulp  diminishes  in  proportion  as  the  pabu- 
lum which  it  distributes  is  of  poor  quality.  In  such  teeth  fillings 
often  prove  more  durable  after  devitalization  ;  the  tooth  is,  how- 
ever, liable  to  the  diseases  which  follow  devitalization. 


58  DENTAL    PATHOLOGY   AND    THERAPEUTICS. 

DEVITALIZATION  OF  DENTAL  PULP. 

439.  What  are  the  four  means  of  devitalizing  a  pulp  ? 

1st,  cauterization  ;  2d,  instrumentation ;  3d,  partial  luxation  ; 
4th,  appropriate  medicament. 

440.  What  is  actual  cauterization? 

It  consists  in  heating  a  fine  wire  to  a  white  heat  and  plunging 
it  into  the  pulp  (obsolete),  or  in  the  appropriate  use  of  the  electrical 
cautery. 

441.  What  is  potential  cauterization? 

The  application  of  nitrate  of  silver,  caustic  potash  or  Vienna 
caustic  (quicklime  and  caustic  potash,  equal  parts,  made  into  a 
paste  with  alcohol).     (Methods  obsolete.) 

442.  What  is  instrumentation? 

1st,  broaching — the  act  of  quickly,  piercing,  twisting  and 
extirpating  by  means  of  smooth  or  barbed  broaches  (admissible 
only  in  centrals  and  cuspids) ;  2d,  puncturing — the  act  of  punct- 
uring acetate  of  morphia  paste,  muriate  of  cocaine,  dental 
tincture  of  aconite  or  arsenious  oxide  paste  into  a  pulp  by  means 
of  gradual  and  repeated  thrusts  with  an  exceedingly  fine  puncture- 
probe  prior  to  extirpation.  Care  must  be  taken  not  to  pass 
through  apical  foramen. 

443.  What  is  luxation? 

A  partial  extraction  of  the  tooth,  by  means  of  which  exter- 
nal connection  with  pulp  is  severed  and  devitalization  follows. 
It  is  then  to  be  gradually  returned  into  place  and  properly  guarded 
against  irritation  from  occlusion. 

444.  What  is  meant  by  devitalization  with  appropriate  medi- 
cament ? 

The  use  of  some  medicament  which  shall  either  kill  the  pulp 
through  its  own  impress  or  so  obtund  it  that  pressure  may 
accomplish  the  desired  end. 

445.  What  is  an  impress  ? 

In  this  connection  it  means  the  production  of  a  dynamic  vital 
irritation.     (See  89.) 

446.  What  is  arsenious  oxide? 

An  oxide  of  the  metal  arsenic,  obtained  from  Bohemia  and 
Saxony  during  the  smelting   of   cobalt  ores;  also   obtained  by 


MEMORANDA. 


MEMORANDA. 


COMPLICATED    CARIES.  59- 

roasting  the  arsenical  sulphide  of  iron,  which  oxidizes,  forming 
arsenious  oxide  (AsjOg);  this  is  then  resublimed.  (See  Phar- 
macopoeia.) 

447.  What  are  the  tests  for  adulteration  of  arsenic? 

1st,  by  subliming  on  metaV plate;  residuum  indicates  impurity ; 
2d,  blow-pipe  test  gives  odor  of  garlic,  indicating  arsenic. 

448.  Name  the  principal  tests  for  the  presence  of  arsenic. 
The  ammoniacal  nitrate  of  silver  test.  Marsh's  test,  Reinsch's 

test. 

449.  Which  test  is  usually  employed  in  dentistry? 
Reinsch's  test.     (See  any  work  on  Chemistry.) 

450.  What  are  the  characteristics  of  arsenious  oxide  ? 
Sublimes  at  425°  Fahr.;  condenses  into  octahedral  crystals; 

has  no  smell  except  when  burned ;  has  a  faint,  sweetish  taste ; 
sparingly  soluble  in  cold  water;  largely  soluble  in  boiling  water; 
very  soluble  in  alkaline  solutions  and  in  hydrochloric  acid;  is  not 
at  all  soluble  in  creasote,  oily  carbolic  acid  or  oil  of  cloves ;  forms 
compounds  of  arsenites. 

451.  When  and  by  whom  was  arsenic  introduced  into  dental 
practice  ? 

Introduced  by  Dr.  John  R.  Spooner,  of  Montreal,  and  made 
known  to  the  profession  in  1836  by  his  brother,  Dr.  S.  Spooner. 

452.  Why  is  arsenic  called  a  dynamic  vital  irritant  ? 
Because  of  the  very  small  quantity  necessary  to  produce  such 

decided  impress  and  such  extended  devitalization  of  tissue. 

453.  What  experiments  prove  this  ? 

A  large  frog  may  be  killed  and  preserved  from  putrescence  by 
the  persistent  application  of  one-twenty-fifth  of  a  grain  of 
arsenic  to  its  leg;  arsenic  may  then  be  found  in  every  portion  of 
its  body. 

454.  What  action  has  arsenic  internally  ? 

Tonic,  antiperiodic,  pulmonic,  detergent,  escharotic  or  a  vital 
irritant  poison,  according  to  the  size  of  the  dose. 

455.  What  is  a  tonic  dose  ? 

One-twentieth  to  one-tenth  of  a  grain  three  times  a  day. 

456.  What  is  the  quantity  used  in  pulp  devitalization? 
One-fiftieth  to  one-twenty-fifth  of  a  grain. 


60  DENTAL    PATHOLOGY   AND    THERAPEUTICS. 

457.  What,  then,  in  case  of  the  loosening  of  an  arsenical 
application,  are  the  safest  things  that  can  happen? 

1st,  ejection  from  the  mouth  ;  2d,  swallowing  (tonic). 

458.  Do  arsenical  applications  ever  act  injuriously  systemically 
through  the  pulp  ? 

Yes ;  in  rare  but  seemingly  well  authenticated  cases  symptoms 
of  systemic  arsenical  poisoning  from  pulp  devitalization  have 
occurred  without  perceptible  local  irritation. 

459.  What  action  has  arsenic  on  the  dental  pulp  ? 
It  is  a  dynamic  vital  irritant  only.     (See  454.) 

460.  What  action  has  it  on  gum  tissue  ? 

It  is  a  sure  cause  of  death  of  the  part  unless  removed.  (See 
453.) 

461.  When  arsenic  destroys  the  gum,  what  is  the  appearance 
of  the  part? 

The  usual  darkened,  discolored  and  turgid  appearance  of  slough- 
ing tissue. 

462.  What  is  the  remedy  for  this  condition? 

Scraping  or  burring  out  the  darkened  and  softened  parts  until 
tissue  capable  of  healthy  granulation  is  reached ;  dress  with  styp- 
tic cotton  and  soothing,  healing  medicaments,  as  tincture  of 
calendula  or  phenol  sodique. 

463.  In  what  forms  is  arsenic  used  ? 

In  powdered  form ;  in  pastes ;  in  devitalizing  fibre.  (See 
Medicaments.) 

464.  What  four  considerations  govern  the  application  of  arse- 
nic to  a  pulp  ? 

1st,  proper  preparation  for  application ;  2d,  proper  placing  of 
medicament ;  3d,  proper  guarding  against  danger  to  gums,  tongue, 
lips  and  cheeks ;  4th,  proper  maintenance  in  position. 

465.  What  of  proper  preparation  ? 

Leave  all  edges  possible ;  syringe  cavity  with  warm  water ; 
excavate  painlessly  to  a  concavity ;  gently  enlarge,  if  possible,  the 
orifice  of  pulp  exposure ;  stop  pain,  if  aching,  that  pulp  may  be 
quiet  when  the  arsenical  impress  is  made. 

466.  Why  is  it  improper  to  apply  arsenic  to  an  inflamed  pulp  ? 
Because  its  inflamed  condition  prevents  the  induction  of  the 

proper  impression. 


MEMORANDA. 


MEMORANDA. 


COMPLICATED    CARIES.  61 

4(17.  What  is  the  effect  of  arsenic,  when  applied,  upon  a  partially 
devitalized  pulp  ? 

It  is  probable  that  no  effect  Avould  be  produced. 

468.  What  of  proper  placing  ? 

Place  accurately  by  cotton  or  probe  on  the  pulp  in  such  tempera- 
ments as  have  dominating  bilious  or  lymphatic  attributes,  and 
near  the  pulp  in  such  temperaments  as  have  dominating  nervous 
or  sanguine  attributes.  Be  careful  not  to  get  arsenic  on  gum  ; 
apply  obtundents  on  a  separate  pellet  of  cotton. 

469.  How  is  arsenic  applied  by  puncture  ? 

By  puncturing  with  a  sharp  probe  directly  into  the  bulbous 
portion  of  the  pulp  or  larger  portions  of  canals. 

470.  What  is  the  danger  in  arsenical  applications? 
The  escape  of  arsenic  from  the  cavity. 

471.  Where  is  devitalizing  fibre  used? 

In  cases  where  danger  exists  to  gum  tissue  or  where  only 
shallow  "pockets"  are  obtainable. 

472.  What  is  a  pocket  ? 

A  hole  drilled  into  a  tooth  in  the  direction  of,  and  as  near  as 
possible  to,  the  pulp,  in  which  arsenic  is  applied  for  the  purpose  of 
devitalization.  It  is  usually  made  in  such  a  position  that  it  may 
be  enlarged  into  a  tap-hole  ? 

473.  When  are  pockets  especially  indicated  ? 

When  cavities  of  exposure  are  so  situated  as  to  forbid  proper 
ingress  to  pulp  canals,  and  especially  if  they  impinge  upon 
cementum. 

474.  What  is  taught  of  proper  guarding  ? 

As  the  cervical  portion  of  the  tooth  is  reached  the  danger 
from  leakage  increases. 

475.  What  precedes  an  arsenical  application  in  approximal 
cavities? 

The  pressing  against  the  gum,  between  the  teeth,  of  an  elon- 
gated pellet  of  cotton  saturated  with  oily  carbolic  acid. 

476.  What  three  purposes  does  this  subserve  ? 

1st,  mechanically  presses  gum  away  from  the  cavity ;  2d,  offers 
a  mechanical  and  medicinal  barrier  to  the  passage  of  arsenic 
(see  450);  3d,  eschars  the  mucous  membrane.  Arsenic  will  not 
pass  through  dead  tissue. 


62  DENTAL    PATHOLOGY    AND    THERAPEUTICS. 

477.  How  should  an  approximal  cavity  opposite  to  that  in 
which  an  arsenical  application  is  to  be  made  be  guarded  from  the 
arsenic  ? 

By  filling  it  either  permanently  or  with  temporary  stopping. 

478.  How  should  the  cheek  or  lip  be  guarded  in  cases  of  ligated 
arsenical  applications  in  shallow  buccal  or  labial  cavities  ? 

By  ligating  over  the  application,  rubber  dam  or  rubber  cloth, 
or  by  placing  between  the  application  and  the  cheek  or  lip  muslin 
or  rubber-cloth  shield  or  compress ;  allow  the  application  to 
remain  a  short  time  only  (an  hour  or  two),  until  sensitivity  is 
obtunded;  then  make  a  securely-covered  application. 

479.  What  are  the  methods  of  maintaining  in  position  an 
arsenical  application  ? 

1st,  by  cotton  and  oily  carbolic  acid,  secured  Avith  sandarac  or 
mastic  varnish ;  2d,  by  temporary  stopping ;  3d,  by  oxyphosphate 
or  nitro-phosphate  of  zinc;  4th,  by  "  facing "  amalgam.  Method 
No.  1  is  used  when  depth  of  cavity  and  retaining  periphery  permit. 
Temporary  stopping  may  cover  applications  of  long  duration  and  be 
used  in  cavities  too  shallow  to  permit  the  use  of  cotton ;  it  is  non- 
leaking.  Methods  Nos.  3  and  4  are  to  be  used  over  applications 
of  long  duration,  in  connection  with  marked  exposure  to  attrition  ; 
unlike  all  other  plastic  filling  materials,  they  are  non-leaking. 

480.  What  length  of  time  is  needful  and  possible  for  arsenical 
applications  ? 

From  three  or  five  hours  to  one  or  more  weeks  is  usually  need- 
ful, but  it  is  possible  that  arsenic  may  remain  until,  from  pulp 
putrescence,  peridental  irritation  is  induced. 

481.  Why  is  it  ever  left  thus  long  ? 

That  the  most  complete  devitalization  may  permit  the  most 
painless  extirpation. 

482.  If  arsenic  be  sealed  in  the  pulp  cavity  of  a  perfectly 
developed  tooth,  will  it  pass  through  dentine  and  cementum  ? 

It  will  not. 

483.  Why  is  this  the  case,  when  arsenic  will  pass  through 
dentine  and  affect  the  pulp  ? 

Dead  dentine  will  prevent  its  passing  to  cementum,  while 
living  dentine  will  insure  its  passage  to  the  pulp. 


xMBMORANDA. 


MEMORANDA. 


COMPLICATED    CARIES.  63 


484.  How  is  arsenic  introduced  into  the  pulp  tissue  ? 
Through  the  medium  of  the  circulation. 

485.  What  is  usually  the  first  effect  of  an  arsenical  application 
upon  a  pulp  ? 

It  produces  "determination"  of  blood,  with  its  concomitant 
pain  and  throbbing. 

486.  If  the  irritation  cannot  be  carried  beyond  this  point  what 
is  to  be  done  ? 

Remove  application,  syringe,  soothe  pulp,  and  renew  appli- 
cation. If  still  the  same  result,  puncture  an  application  into  the 
pulp. 

487.  What  follows  "  determination  ?  " 

"  Congestion,"  with  its  concomitant  fullness  and  loss  of  sensa- 
tion. 

488.  How  does  "  congestion  "  devitalize  the  pulp  ? 
By  causing  cessation  of  nutrition. 

489.  Does  "true  inflammation"  ever  ensue? 

Sometimes.  Indicated  by  severe  paroxysms  of  throbbing  pain, 
which  follow  the  dull  feeling.  They  are  often  bearable  and  will 
generally  pass  away  in  a  half  hour.  This  true  inflammation  adds 
to  the  congestion,  there  being  three  or  four  waves  of  congestion, 
of  about  ten  minutes  each. 

490.  Does  arsenic  pass  through  the  apical  foramen  of  a  fully- 
formed  tooth  ? 

It  does  not,  unless  forced  through,  because  its  absorption  is 
interfered  with  by  congestion.     (See  78.) 

491.  What  is  taught  regarding  cause  and  treatment  of  any 
peridental  irritation  Avhich  supervenes  upon  arsenical  devitalization? 

Its  cause  is  not  directly  referable  to  arsenical  irritation,  but 
to  the  nutrient  effusion  of  "  determination  "  previous  to  the  estab- 
lishment of  new  channels  of  circulation.  Treatment — In  marked 
cases  apply  dental  aconite  to  gum  persistently ;  in  sthenic  patients 
also  spot  with  dental  iodine. 

492.  What  proofs  exist  that  arsenic  is  not  absorbed  by  the 
pulp  of  a  fully-formed  tooth  ? 

1st,  if  absorbed  it  would  preserve  the  pulp,  Avhereas,  as  a 
rule,  it  putresces  in  due  season;  2d,  Reinsch's  test,  which  detects 
^ .-  1  Q  Q  of  a  grain,  shows  no  arsenic  in  the  dead  pulp. 


64  DENTAL    PATHOLOGY    AND    THERAPEUTICS. 

493.  What  result  in  connection  with  tooth  tissue  sometimes 
follows  an  application  of  arsenic? 

Suflfusion — a  pinkish  or  purple  discoloration  of  the  crown  and 
neck  of  the  tooth,  caused  by  the  infiltration  of  hfematin  into  the 
dentinal  tubuli. 

494.  What  is  its  treatment  ? 

Open  and  cleanse  canals,  stop  temporarily  above  suffusion,  wash 
with  tepid  water,  and  leave  open  to  the  fluids  of  the  mouth  for  a 
few  days.     Do  not  use  "bleachers." 

495.  What  governs  the  repeated  applications  of  arsenic? 

In  teeth  of  the  upper  jaw,  even  by  instrumentation,  it  is 
comparatively  safe  practice,  though  care  must  be  observed  not  to 
force  arsenic  through  the  apical  foramen.  (See  460).  In  teeth  of 
the  lower  jaw  instrumentation  is  apt  to  force  the  arsenic  through; 
therefore  a  second  application  by  contiguity  (on  pellet  of  cotton) 
is  alone  admissible. 

496.  What  is  meant  by  an  intractable  pulp? 

A  pulp  which  it  is  found  impossible  under  any  circumstances 
to  devitalize  by  arsenical  applications. 

497.  How  are  such  pulps  to  be  treated  ? 

Cover  with,  powerfully-soothing  medicaments  under  concave 
caps,  as  attempts  at  devitalizing  by  other  means  usually  result  in 
loss  of  the  tooth. 

498.  How  are  the  pulps  of  deciduous  teeth  devitalized  ? 

By  inducing  such  gradual  pressure  as  will  be  tolerated  upon 
the  pulp,  by  means  of  cotton  pellets  medicated  with  eucalyptus  or 
cajeput  (alternates),  dental  tincture  of  iodine,  creasote,  carbolic 
acid,  acetate  of  morphia  paste,  muriate  of  cocaine  or  oil  of 
cloves.  These  medicaments  permit  pressure,  which  produces 
congestion,  and  thereby  devitalization  of  the  pulp. 

499.  Where  is  pressure  indicated  ? 

In  deciduous  teeth  and  in  such  of  the  permanent  teeth  as  have 
not  fully-formed  apical  foramina. 

500.  Why  not  use  arsenic? 

It  may  he  applied  for  an  hour  only,  to  prepare  for  pressure,  but 
if  left  longer  it  may  go  through  the  apical  foramen  and  affect  the 
adjoining  tissues.. 


MEMORANDA. 


MEMORANDA. 


COMPLICATED    CARIES. 


65 


501.  What  carries  it  through  the  foramen  in  these  cases  ? 
The  large  foramen  allows  of   free   circulation  and   consequent 

absorption  of  arsenic.     (See  484.) 

502.  What  is  the  guide  to  the  formation  of  roots? 

The  following  table,  obtained  by  a  careful  observation  and 
comparison  of  specimens,  and  which  is  a  reasonably  close 
approximation  to  a  safe  guide.* 


Deciduous  Teeth. 


Tooth. 


Age 
Fully  Calcified, 


Central,  .  .  , 
Lateral,  .  .  , 
Cuspid,  .  .  . 
First  bicuspid. 
Second  bicuspid,t 
First  molar, 
Second  molar. 
Third  molar. 


18  to  24  months. 

24        " 

4  to  .5  years. 


Age  Decalcification 
Commences. 


18  to  24  months. 
24       " 
6  to  7  vears. 


Permanent  Teeth. 


Age 
Fully  Calcified. 


3  to  4  years. 
5      " 


7  to  8  years. 

8  to  9     " 


11  years. 
11 
17  to  18 
17  to  20 
17  to  20 
12  to  14 
20 

As  variable  as  the 
eruption. 


503.  What  are  the  six  considerations  which  maintain  system- 
atic antagonism  in  the  treatment  of  deciduous  and  permanent 
teeth  ? 


1.  Deciduous  teeth  are  for  temporary 

use. 

2.  Deciduous  teeth  are  filled  for  tem- 

porary purposes. 

3.  Deciduous  roots  are  ahsorhing  or 

absorbed  when  the  crowns  need 
attention. 

4.  Irritation  of  pulps  interferes  with 

absorption  of  deciduous  roots. 

5.  Devitalization  of  pulps  prevents 

absorption  of  deciduous  roots. 

6.  Every  consideration  points  to  the 

early  loss  of  rootless  deciduous 
crowns. 


1.  Permanent  teeth  are  for  perma- 

nent use. 

2.  Permanent    teeth    are   filled   for 

permanent  purposes. 

3.  Permanent  roots  are  usually  not 

fully  formed  when  the  crowns 
need  attention. 

4.  Irritation  of  pulps  interferes  with 

formation  of  permanent  roots. 

5.  Devitalization  of  pulps  prevents 

formation  of  permanent  roots. 

6.  Every  consideration  points  to  the 

great  utility  of  even  crownless 
permanent  roots. 


PULSATING  PULPS. 


504.  What  is  meant  by  a  "  pulsating  pulp  ?  " 

One  which  visibly  pulsates  in  unison  with  the  arteries. 


*In  view  of  the  saving  of  teeth  for  long-continued  future  use,  the  importance  of  this 
table  cannot  be  overestimated. 

fAll  the  specimens  examined  indicated  the  tardy  formation  of  the  roots  of  the  bicuspids, 
both  superior  and  inferior. 


66  DENTAL    PATHOLOGY    AND    THERAPEUTICS. 

505.  To  what  is  it  probably  due  ? 
Probably  due  to  enlarged  apical  foramen. 

506.  What  is  the  prognosis  ? 
Unfavorable. 

507.  What  symptoms  distinguish  it  from  pulp  dying? 
Decided  pain,  long-continued  paroxysms  of  severe  suffering, 

soreness  upon  pressure,  throbbing  pain,  and  imperative  demand  for 
relief. 

508.  What  is  the  condition  of  the  health  line  ? 
Perfectly  normal. 

509.  What  is  the  treatment? 

Careful  entrance  of  tooth,  control  of  probable  hemorrhage, 
sedation  of  pulp  with  dental  aconite,  and  careful  devitalization, 
as  for  deciduous  pulps. 

EXTIRPATION  OF  THE  DENTAL  PULP. 

510.  Upon  what  does  the  average  of  success  resulting  from 
this  operation  depend? 

Thoroughness  of  extirpation,  favorable  auspices,  and  after- 
treatment.     (See  530.) 

511.  What  are  the  essentials  to  thorough  pulp  extirpation  ? 
Free   openings,  affording   easy   access   to   pulp   canals,  either 

through  the  cavity  of  decay  or  through  an  opening  made  intention- 
ally for  the  purpose  of  affording  such  ingress,  called  a  "tap-hole." 

512.  What  is  to  be  done  with  the  cavity  of  decay  in  case  it 
does  not  afford  ready  ingress  to  pulp  canals  ? 

Treat  it  as   an  ordinary  cavity,  and  fill  permanently  at  once. 

513.  What  is  the  point  for  "  tap  "  in  each  tooth? 
Superior  centrals  and  laterals  on  lingual  face. 

' '       cuspids  on  tuberosity  or  disto-labially. 

' '        first  or  second  bicuspids  on  articulating  or  buccal  face. 

"        first  molars  on  articulating  (best),  buccal  (next  best), 

or  mesial  face  (fair). 
"       second  molars  on  articulating,  mesio-articulating  or 

bucco-articulating  face. 
' '        third  molars  on  mesio-articulating  face. 
Inferior  centrals  and  laterals  on  lingual  face,  just  posterior  to 

cutting  edge. 
"        cuspids  on  disto-labial  portion,  near  the  gum. 
"        bicuspids  on  mesio-buccal  face. 
"        first,  second   and  third   molars  on  mesial,  buccal  or 

mesio-articulating  face. 


MExMOKANDA. 


MEMORANDA. 


COMPLICATED    CARIES.  Qf 


514.  What  is  the  method  of  tapping? 

Spot  enamel  with  diamond  or  inverted-cone  drill,  and  enter 
pulp  cavity  with  spear-pointed  drill ;  enlarge  this  opening  with 
successive  sizes  of  rose  drills  until  the  contour  lines  of  the  pulp 
cavity  are  obliterated;  syringe  with  tepid  water. 

515.  What  is  the  first  indication  in  pulp  extirpation? 
Probe  gently  to  ascertain  as  to  sensation. 

516.  What  does  sensation  indicate  ? 

That  the  pulp  is  not  thoroughly  devitalized  and  that  it  should 
be  obtunded,  or  that  a  second  application  of  arsenic  should  be 
punctured  into  it.     (See  469.) 

517.  What  is  the  danger  to  broaches  in  extirpating? 
Breaking  them  off  in  the  canal. 

518.  What  is  the  objection  to  leaving  a  broken  broach  or 
probe  in  the  canal  ? 

It  presents  a  mechanical  barrier  to  future  venting  of  the  tooth. 

519.  What  methods  are  recommended  for  removal  of  such 
broken  fragment  of  broach  ? 

If  broach  is  loose,  leave  common  salt  in  the  cavity  for  a  few 
days,  when  it  can  be  easily  removed,  or  draw  it  out  by  means  of 
a  magnetized  probe ;  if  tight,  bur-drill  around  broach  till  end  i& 
exposed  and  lift  out  with  pliers. 

520.  Give  the  treatment  of  canal  in  single-rooted  teeth. 

Extirpate  as  thoroughly  as  possible  ;  syringe  out  remaining  fila- 
ments with  tepid  water;  clean  with  alcohol  and  glycerine,  and  intro- 
duce taper-twisted  dressings  of  cotton  dipped  in  fluid  cosmoline^ 
not  filling  the  canal  flush  with  the  pulp  chamber ;  place  a  small  ball 
of  cotton  in  the  mouth  of  the  canal. 

521.  What  is  this  called  ? 

The  "  guard  pellet."  Its  use  is  to  prevent  the  sudden  drawing 
down  of  the  cotton  dressing  when  drilling  near  the  pulp  cavity. 

522.  Give  treatment  of  canals  in  multirooted  teeth. 
Beginning  with  the  largest,  extirpate  and  prepare  each  in  turn, 

as  in  single-rooted  teeth ;  the  cotton  dressings  are  thus  not 
disturbed  nor  canals  refilled  with  debris  during  the  preparation  of 
smaller  canals ;  as  a  last  thing,  prior  to  temporarily  stopping  the 
tooth,  work  medicament,  by  means  of  fine  probes,  into  the 
smallest  canals. 


68  DENTAL    PATHOLOGY    AND    THERAPEUTICS. 

523.  What  medicaments  are  recommended  for  use  in  fine  or 
tortuous  canals  where  devitalization  has  been  only  partial  ? 

Puncture  acetate  of  morphia  paste,  with  or  without  muriate  of 
cocaine ;  if  this  does  not  satisfactorily  obtund  the  sensitivity, 
puncture  deliquesced  chloride  of  zinc. 

524.  What  medicaments  are  recommended  for  ordinary  canal- 
work  after  recent  devitalization  ? 

Fluid  cosmoline,  combined  with  menthol,  acetate  of  morphia 
paste,  eugenol,  oil  of  cloves,  oil  of  cajeput,  oil  of  eucalyptus, 
glycerine,  alcohol,  inspissated  canal  dressing,  iodoform  paste. 

525.  How  long  should  the  tooth  remain  temporarily  stopped  ? 
About  a  week,   or  until  the  irritation  about  the  apical  foramen 

has  subsided.     (See  491.) 

526.  What  is  taught  in  regard  to  hemorrhage  governing  this  ? 
Red   bleeding   is   regarded  as   favorable  (except  in   cases   of 

hemorrhagic  diathesis),  and  is  usually  followed  by  coagulation  and 
prompt  healing  of  parts.  On  the  contrary,  effusions,  or  "  white 
bleeding,"  may  take  place,  enforcing  repeated  stopping  and 
unstopping  before  relieved.  This  occurs  generally  in  patients  of 
the  lymphatic  temperament.  The  safest  method  is  to  allow  time 
for  a  thorough  devitalization  and  separation  of  pulp  from  outside 
tissue  by  sloughing. 

527.  Is  it  always  possible  to  clean  and  fill  to  the  very  apex  of 
all  roots  ? 

No  ;  fine,  tortuous  and  bayonet-shaped  roots  often  render  such 
operations  impossible  of  accomplishment. 

528.  Which  teeth  generally  present  peculiarities  of  root  forma- 
tion ? 

Supeiior  bicuspids  sometimes  have  three  roots ;  superior  second 
molars  have  usually  a  flattened  root  formation ;  sometimes  very  fine, 
hair-like  buccal  canals,  which  cannot  be  even  entered ;  superior 
third  molars  have  frequently  three,  sometimes  four,  occasionally  five 
well-defined  roots  and  canals ;  lower  cuspids  occasionally  have 
two  roots  ;  inferior  first  and  second  molars  have  often  two  mesial 
canals,  sometimes  a  flattened  distal  canal,  and  infrequently  two 
distal  canals,  making  four  canals  to  the  tooth ;  sometimes  three  or 
four  distinct  roots ;  inferior  third  molars  have  usually  two  canals ; 
sometimes  three ;  sometimes  three  roots ;  usually  more  or  less 
curved. 


MEMORANDA. 


MEMORA]S'DA. 


EXO.-TO.SEL.  FUSEL.  ATTACHED  AND  GEMDfOrS  TEETH.    69 

529.  How  are  the  pulps  of  deciduous  teeth  to  be  extirpated  ? 
Partially  extirpate  and  make  vent  after  filling. 

530.  "What  are  the  probabilities  of  a  pulpless  tooth  ? 

The  probabilities  of  a  pulpless  tooth  depend  upon  the  tempera- 
ment, age.  sex.  occupation  and  general  physical  condition  of  the 
individual:  under  favorable  auspices  the  probability  of  durable 
usefulness  is  good ;  under  unfavorable  auspices,  particularly  if 
complicated  with  overwork,  previous  pjeriodontitis  or  alveolar 
abscess,  the  probabilities  for  continued  future  usefulness  are  much 
decreased. 

581.  "What  are  the  possibilities  of  a  pjulpless  tooth  ? 

Though  all  work  be  properly  done,  trouble  may  promptly 
supervene  ;  while  sometimes,  even  though  work  be  not  properly 
done,  long-continued  service  may  result. 

532.  Which  teeth  give  better  promise  of  success,  upper  or 
lower  '.'      Whv  ■' 

The  upper.  Because  of  the  vitality  and  cellular  character  of  the 
surrounding  osseous  structure,  and  from  the  fact  that  in  the  lower 
jaw  gravity  favors  the  injurious  action  of  the  products  of  both 
acute  and  chronic  inflammation,  producing  recurrent  troubles, 
abscesses,  fistulae,  scars  and  permanent  indurations. 


EXOSTOSED.  ErSED.  ATTACHED  A^T)  GEMINOUS 

TEETH. 

DEXTAL  EXOSTOSIS. 

533.  "What  is  dental  exostosis  '.' 

A  hypertrophied  condition  of  the  cementum, 

534.  What  is  the  cause  of  this  disease? 

Any  irritation  which  would  continuously  stimulate  the  func- 
tional action  of  the  peridental  membrane  without  exceeding  its 
nutrient  capabilities. 

535.  What  time  is  required  for  its  development? 
Many  months,  and  usually  many  years. 

536.  Through  what  stages  does  this  disease  pass  ? 

Through  irritation,  thickened  peridentium.  effusion,  coagulation 
and  cartilasinous  and  cemental  orcranization. 


TO  DENTAL    PATHOLOGY   AND    THERAPEUTICS. 

537.  What  is  the  appearance  of  this  cemental  organization  or 
exostosis  ? 

Sometimes  chalky ;  sometimes  moderately  dense  and  yellowish- 
white  ;  sometimes  hard  and  polished. 

538.  What  is  its  form  ? 

1st,  nodular ;  2d,  circumscribed  or  apical ;  3d,  extended  or 
diffused. 

539.  What  is  the  condition  of  the  health  line  in  circumscribed 
or  apical  exostosis  ? 

Perfectly  normal. 

540.  At  what  age  does  exostosis  occur  ? 

Usually  found  upon  the  teeth  of  adult  and  aged  persons. 

541.  What  is  the  relative  liability  of  teeth  to  exostosis  ? 
Twenty-five  per  cent,  of  exostosed  teeth  are  incisors  and  cus- 
pids ;  seventy-five  per  cent  are  bicuspids  and  molars. 

542.  What  are  the  mechanical  causes  which  might  produce 
exostosis  ? 

Any  undue  mechanical  irritation  which  is  possessed  of  frequency 
if  strong  or  persistence  if  weak  may,  in  due  time,  provoke  an 
exostosed  condition.  The  gentle  knocking  of  the  teeth  together 
during  thought,  the  cracking  of  nuts  and  other  hard  substances 
with  the  teeth,  the  biting  off  of  threads,  mal-occlusion  of  teeth, 
slight  protrusion  of  fillings  at  cervical  margin  under  the  gum,  and 
the  slow  deposition  of  tartar  under  the  free  edge  of  the  gum 
are  mechanical  causes  of  this  disease. 

543.  Name  the  vital  causes. 

Non-occlusion,  large  metallic  plugs,  especially  large  root  fillings 
(from  unpleasant  conduction  of  heat  and  cold),  dental  caries,  alve- 
olar abscess,  necrosed  roots  and  other  exostosed  teeth  or  roots. 

544.  What  connection  has  dental  caries  with  this  disease? 

It  is  a  very  frequent  cause,  and  is  dependent  upon  three  con- 
siderations : 

Mrst.  Position. — This  must  be  under  the  free  edge  of  the  gum 
and  encroaching  upon  the  roots. 

Second.  Extent. — These  cavities  need  not  necessarily  be  very 
large ;  but  if  not,  should  encroach  more  upon  cemental  than  denti- 
nal structure. 


MEMORANDA. 


MEMOKANDA. 


BXOSTOSED,  FUSED,  ATTACHED  AND  GEMINOUS  TEETH.         71 

Third.  Character  of  Decay. — The  slow  variety  of  decay  is 
more  likely  to  produce  exostosis  than  the  more  rapidly-progressing 
caries. 

545.  What  are  the  symptoms  of  exostosis  ? 

If  the  pain  is  localized  in  immediate  proximity  to  a  tooth  it  is 
a  dull,  gnawing,  uneasy  sensation,  referable  to  the  suspected  tooth, 
not  absolutely  persistent,  but  remittent  or  even  intermittent, 
without  periodicity,  except  Under  malarial  influences;  paroxysms 
never  acute,  but  sufficiently  severe  and  lengthy  (twelve  to  four- 
teen hours)  rather  than  intense ;  sometimes  constant  and  disagree- 
able uneasiness,  without  severity ;  some  peculiar  response  to 
pressure  and  tapping,  but  not  decided ;  also  a  peculiar  response 
to  thermal  changes.  The  gradual  development  of  the  pain  is 
also  a  diagnostic  symptom. 

546.  What  is  the  range  of  sympathetic  trouble  caused  by  den- 
tal exostosis  ? 

Cheekache,  jawache,  tic-douloureux,  otalgia,  tinnitus  aurium, 
cophosis,  ophthalmalgia,  amblyopia,  amaurosis,  cephalalgia,  neu- 
ralgic pains  in  distant  parts  of  the  body,  paralysis  (especially  of 
face,  arms  or  hands),  and  even  fits,  as  catalepsy  and  epilepsy. 

547.  What  is  the  medium  of  association  of  exostosed  teeth 
with  distant  parts  of  the  body  ? 

The  fifth  pair  of  nerves  and  its  relation  sympathetically  with 
the  whole  economy. 

548.  What  is  the  treatment  for  exostosis  ? 
Careful  and  complete  extraction. 

549.  What  is  the  danger  in  extraction  ? 

The  fracture  of  the  roots  from  tightening  in  the  alveolus; 
also  of  fracture  of  the  jaw  and  removal  of  adjoining  teeth. 

550.  What  is  the  method  of  removing  the  remnant  of  the 
fractured  root  ? 

As  in  absorption  of  permanent  roots.     (See  412.) 

551.  What  might  be  the  treatment  of  exostosis  ? 
Extraction,  removal  of  exostosis  and  replantation. 

552.  What  is  taught  of  this  ? 

This  operation  is  questionable  in  proportion  as  the  lesion  for 
which  the  extraction  has  been  resorted  to  is  severe. 


72  DENTAL    PATHOLOGY   AND    THERAPEUTICS. 

FUSED  TEETH. 

553.  What  are  fused  teeth  ? 

Two  or  more  teeth  joined  together  by  a  cemental  union  of 
their  roots,  but  having  an  individual  and  separate  pulp  for  each 
tooth. 

554.  What  are  the  causes  of  fused  teeth  ? 

Any  cause  which  will  produce  exostosis  of  sufficient  extent  ? 

555.  What  are  the  symptoms  ? 

The  same  as  those  of  exostosis,  if  any. 

ATTACHED  TEETH. 

556.  What  is  the  peculiarity  of  these  ? 

1st,  they  have  separate  pulps ;  2d,  their  intervening  osseous 
and  membranous  tissues  mechanically  attach  their  roots  in  an 
ap23arent  but  not  actual  union  of  cementum  and  bone. 

GEMIN0U8  TEETH. 

557.  What  is  the  peculiarity  of  these  ? 
They  have  but  one  pulp. 

558.  What  is  the  cause  of  geminous  teeth  ? 
The  presence  of  a  geminous  pulp-germ. 

559.  What  operation  in  connection  with  these  teeth  is  improper  ? 
Separation  of  crowns ;  inasmuch  as  the  pulp  cavity  will  be 

opened. 

560.  What  is  the  relative  liability  of  teeth  to  gemination  ? 
Mostly  centrals  and  laterals  ;    sometimes  a  lateral  and  cuspid ; 

very  rarely  molars. 


PERIODONTITIS. 


561.  What  is  periodontitis  ? 

Inflammation  located  in,  or  having  its  inception  in,  the  peri- 
dental membrane. 

562.  What  stages  of  inflammation  does  this  term  include  ? 
All   stages,  from  general  dental  hyperaesthesia,  through  true 

inflammation,  bordering  on  suppuration. 


MEMORANDA. 


MEMORANDA. 


PERIODONTITIS.  73 


f)63.  What  is  the  symptom  of  general  dental  hypersesthesia  ? 
Inability    to    comfortably    masticate    food,  because   of  general 
tenderness  or  marked  sense  of  uneasiness  about  the  teeth. 

564.  What  are  the  three  causes  of  this  condition  ? 

1st,  functional  disturbance — either  gastric,  hepatic  or  general 
nervous ;  2d,  systemic  debility  (predisposing  cause),  owing  to 
changes  of  temperature,  mental  or  physical  "  worry,"  malarial 
impressions  or  other  depressing  influences ;  3d,  systemic  hyper- 
acidity from  fruits,  acids  and  the  like. 

565.  What  is  the  treatment  advised  for  the  first  two  ? 
Refer  patient  to  general  medical  adviser  for  treatment. 

566.  What  for  the  third  ? 

Alkaline  treatment,  systemically,  as  for  sensitive  dentine  pro- 
duced by  acids.     (See  190.) 

567.  What  is  ^Ae  cause  of  periodontitis  ? 

Irritation  of  peridentium,  which,  according  to  amount  of  irrita- 
tion, temperament  and  physical  condition,  produces  periodontitis 
of  every  grade  of  rapidity  of  induction,  degree  of  severity,  length 
of  duration  and  extent  of  complication. 

568.  What  are  the  five  grades  of  periodontitis  ? 

Mrst  Cf-rade. — Such  cases  as  present  with  merely  marked  sore- 
ness of  tooth,  quite  prompt  appearance  of  symptoms,  decided 
restriction  as  to  amount  of  tissue  affected,  and  prompt  resolution 
of  inflammation  and  permanent  cure  upon  either  removal  of  cause 
or  upon  application  of  derivative  or  counter-irritant  medication. 

Second  Grrade. — Presents  more  marked  soreness  of  tooth,  less 
prompt  appearance  of  symptoms,  more  extended  tissue  irritation, 
and  resolution  as  deliberate  as  was  the  establishment  of  the  disease 
upon  accurate  and  somewhat  persistent  medication.  This  grade 
occurs  in  patients  of  high-grade  temperamental  attributes. 

Third  Grrade. — Develops  with  sufiicient  celerity  and  presents 
excessive  tenderness  on  pressure,  not  only  upon  the  tooth,  but 
upon  adjoining  teeth,  surrounding  parts  and  cheek  ;  pronounced 
throbbing  and  great  pain ;  general  febrile  excitement  from 
systemic  sympathy,  as  shown  by  flushed  cheeks  and  quick  pulse ; 
imperative  demand  for  relief,  which  should  be  promptly  afforded 
with  the  utmost  gentleness,  using  accurate  counter-pressure  if 
drilling  vent ;  accuracy  and  thoroughness  of  either  stimulant  or 


74  DENTAL    PATHOLOGY    AND    THERAPEUTICS. 

refrigerant  medication,  according  to  physical  condition  ;  the  pre- 
cluding of  irritation  by  appropriate  guard,  together  with  persistence 
in  combating  recurrence  of  trouble,  is  required. 

Fourth  Grade. — Diagnosed  by  the  necessity  of  almost  imme- 
diate abandonment  of  antiphlogistic  treatment  as  useless,  and  the 
induction  of  suppuration  by  the  systematic  stopping  and  unstop- 
ping of  the  tooth  if  pulpless,  or  by  the  use  of  stimulating  medica- 
ments upon  the  gum,  or  both,  as  is  most  acceptable  to  the  patient. 

Fifth  Grade. — Generally  occurs  in  sanguo-nervous,  bilio- 
nervous  or  lymphatico-nervous  temperaments,  or  in  nervo-sanguine 
if  systemically  adynamic.  The  various  phases  of  violent  acute 
imflammation  rapidly  succeed  each  other  with  increasing  intensity, 
defying  all  antiphlogistic  treatment,  extending  to  adjoining 
teeth  and  inducing  systemic  sympathy.  Immediate  extraction 
of  the  affected  tooth  and  persistent  antiphlogistic  treatment  of  the 
alveolar  walls  and  adjoining  teeth  is  indicated.  Even  this  some- 
times fails  to  save  the  adjoining  teeth. 

569.  What  are  the  seventeen  recognized  causes  of  periodontitis? 

1.  Want  of  occlusion. 

2.  Mal-occlusion. 

3.  Salivary  calculus  or  tartar. 

4.  Looseness  of  tooth  or  root. 

5.  Induration  of  tooth  tissue. 

6.  Cavity  of  decay  impinging  on  the  cementum. 

7.  Mechanical  irritation. 

8.  Dental  manipulation. 

9.  Excess  of  filling  material. 

10.  Inflammation  of  pulp. 

11.  Excision  of  pulp  without  alleviating  hemorrhage. 

12.  External  irritation  by  forcible  vrithdrawal  of  pulp. 

13.  Putrescent  pulp. 

14.  Previous  periodontitis. 

15.  Action  of  medicine  locally. 

16.  Action  of  medicine  systemically. 

17.  Action  of  virus. 

570.  How  does  want  of  occlusion  cause  periodontitis  ?  Its 
remedy  ? 

By  efforts  for  exfoliation.  Remedy — When  practicable,  estab- 
lish occlusion. 

571.  What  ai"e  the  causes  of  mal-occlusion  ? 

1st,  natural  or  acquired  irregularity ;  2d,  change  of  position  of 
teeth  consequent  upon  extraction. 


MEMORANDA. 


MEMORANDA. 


PERIODONTITIS.  75 


572.  "What  i?  the  natural  moving  tendency  of  teeth  in  the 
mouth  '.' 

The  first  bicuspids  tend  to  remain  stationary  ;  the  teeth  anterior 
ta  these  tend  to  move  backward  and  those  posterior  to  move  for- 
ward, as  instanced  by  the  tilting  of  a  second  molar  upon  the 
extraction  of  a  first  molar  in  middle  life,  or  the  annoying  sepa- 
ration of  the  centrals  upon  extraction  of  a  lateral,  cuspid  or  the 
bicuspids. 

573.  How  do  salivary  calculus  and  tartar  cause  periodontitis  ? 
By  insinuating  themselves  beneath  the  free  edge   of  the   gum, 

thus  irritating  the  pericementum. 

574.  What  is  taught  of  their  removal  ? 
They  should  be  thoroughly  removed. 

575.  What  is  the  remedy  for  periodontitis  caused  by  undue 
leverage  upon  loose  teeth  or  roots  ? 

1st,  excising  all  or  part  of  crown  :  the  remaining  portion  may 
comfortably  sustain  a  clasp  plate  ;  2d,  joining  a  loose  tooth 
to  a  firm  one  by  filling  them  together  ;  3d,  ligation  with  platinum 
or  gold  wire. 

576.  What  is  induration  of  tooth  tissue  ? 

Hypercalcification  of  cementum,  tending  to  produce  ex- 
foliation. 

577.  What  is  its  cause  ? 
Systemic  influence. 

578.  What  is  its  treatment? 

Nothing  can  be  done;  extraction  is  the  only  relief  for  the 
periodontitis. 

579.  How  do  cavities  of  decay  impinging  upon  the  cementum 
cause  periodontitis  ? 

1st,  by  retention  of  food,  irritating  from  pressure  and  putres- 
cence ;  2d,  by  presenting  a  roughened  edge,  "which  irritates  the 
adjoining  gum  tissue. 

580.  What  is  the  treatment  of  such  cavities  as  are  occupied  by 
hypertrophied  gum  ? 

Syringe  cavity  and  gently  insert  one  end  of  a  loosely-rolled 
rope  of  cotton  medicated  with  a  soothing  application :  fill  cavity 
with  the  remainder  of  the  rope,  thus  gradually  pressing  the  gum 
from  the  cavity. 


76  DENTAL    PATHOLOGY    AND    THERAPEUTICS. 

581.  What  are  the  mechanical  causes  of  irritation  ? 

The  undue  use  of  one  side  of  a  denture;  the  mastication  of 
unduly -hard  food;  cracking  of  nuts  or  other  abuse  of  like  kind; 
Mows  upon  the  teeth  or  jaw  producing  contusion  or  fracture  and 
peridental  irritation,  ranging  from  slight  irritation  to  that  of 
yiolence  sufficient  to  cause  death  of  the  pulp  and  even  of  the 
tooth  itself;  fractures  in  teeth  involving  the  cementum. 

582.  What  is  the  treatment  of  split  teeth? 

Draw  parts  together  with  ligatures;  properly  prepare  pulp 
cavity  and  canals;  fill  the  pulp  chamber  and  cavity  with  zinc 
phosphate  or  amalgam  in  such  manner  as  shall  mechanically  unite 
the  parts ;  or  platinum-band  the  crown,  securing  with  plastics.  ■ 
In  cases  of  split  root,  "ring-bolt."  (See  Plastics  and  Plastic 
Fillings^  p.  138.) 

583.  When  is  "dental  manipulation"  a  cause  of  periodontitis? 
Whenever  an    operation,  whether  severe   or  even  the  gentle 

stopping  of  a  tooth  with  cotton,  is  performed  contrary  to  indica- 
tions, "  dental  manipulation  "  is  responsible  for  the  resulting  peri- 
odontitis. 

584.  In  what  four  locations  does  excess  of  filling  material 
■cause  periodontitis  ? 

1st,  on  the  articulating  face,  causing  mal-occlusion  ;  2d,  at  the 
cervical  edge  of  such  cavities  as  impinge  upon  the  cementum  and 
interfere  with  gum  tissue ;  3d,  in  excess  of  contour,  mesially  or 
distally,  maintaining  a  wedged  condition ;  4th,  by  protrusion 
through  apical  foramen  or  perforation. 

585.  How  is  excess  on  the  articulating  surface  to  be  diag- 
nosed ? 

By  the  sensation  of  the  patient,  the  sight  of  the  practitioner 
and  the  sound  of  the  occluding  teeth. 

586.  What  is  the  sensation  of  the  patient  which  indicates  a 
second  removal  of  excess  ? 

The  doubtful  manner  of  "thinking"  all  to  be  right.  If  right, 
all  hesitation  will  disappear. 

587.  How  is  occasional  mal-occlusion  during  eating  diagnosed 
to  be  due  to  excess  of  filling  material  ? 

With  pumice  remove  the  bright  polish  from  the  articulating 
face  of   the  filling  and  allow  to  go  for  a  few  days ;  a  bright  spot 


MEMORANDA. 


MEMORANDA. 


PERIODONTITIS.  77 


on  the  face  of  the  filling  indicates  the  point  of  mal-occliision. 
Impression  -  paper  is  also  an  efficacious  adjunct;  when  placed 
between  teeth  and  bitten  upon  it  leaves  a  spot  upon  the  filling, 
indicating  excess. 

588.  What  is  taught  of  the  relativity  of  amount  of  excess  of 
filling  material  at  the  cervical  edge  and  the  degree  of  irritation 
induced  ? 

They  have  no  relation.  All  depends  upon  the  susceptibility  of 
the  patient  to  irritation ;  therefore  the  slightest  amount  of  excess 
should  be  carefully  removed. 

589.  What  is  the  remedy  for  excess  in  contour  ? 
Filing  off  the  contour  until  comfort  is  obtained. 

590.  What  is  the  treatment  for  excess  through  apical  foramen  ? 
No  cure  can  be  effected  unless  the  cause  is  removed. 

591.  In  what  manner  does  inflammation  of  a  pulp  cause 
periodontitis  ? 

By  extension  of  the  inflammation  outside  of  the  apical  foramen. 

592.  What  is  the  one  reliable  diagnostic  symptom  ? 

The  duplex  character  of  the  pain.  To  the  tenderness  upon 
pressure  is  added  the  paroxysmal  pain  of  pulp  irritation. 

593.  What  is  the  treatment  for  this  condition  ? 

Soothe  pulp,  utilizing  an  existing  cavity  of  decay,  or  removing 
filling,  or  making  a  pocket ;  follow  this  with  devitalizing  appli- 
cations ;  in  addition  treat  the  periodontitis. 

594.  If  devitalization  does  not  give  relief,  what  is  to  be  done  ? 
Attempt  suppuration ;  if  unsuccessful,  drill  through  the  alveolar 

process  for  vent;  this  failing,  extraction  is  the  only  means  for 
relief. 

595.  How  many  varieties  of  hemorrhage  exist  ? 
Red  bleeding  and  white  bleeding  (efiusions). 

596.  What  should  be  done  with  hemorrhage  having  its  source 
at  the  apex  of  a  tooth  ? 

It  should  be  allowed  free  vent  through  the  canals. 

597.  How  may  it  cause  periodontitis? 

Through  arrestation  by  styptic  medication  or  by  filling. 

598.  What  is  the  proper  treatment  of  the  tooth  ? 

When  hemorrhage  occurs,  leave  canals  open,  place  absorbent 
cotton  in  the  pulp  cavity,  and  stop  tooth  temporarily. 


78  DENTAL    PATHOLOGY    AND    THERAPEUTICS. 

599.  How  does  forcible  withdrawal  of  pulp  cause  periodon- 
titis ? 

By  retraction  of  tissue  external  to  apical  foramen. 

600.  How  is  this  to  be  treated? 

By  applications  of  strong  soothers,  as  eugenol,  menthol,  acetate 
of  morphia  paste,  dental  aconite  or  muriate  of  cocaine  in  canals ; 
aconite  and  iodine  to  gum,  with  continuous  applications  of  solution 
of  bimeconate  of  morphia,  fluid  extract  of  piscidia  or  hamamelis 
upon  the  gum  by  means  of  pads. 

601.  What  is  the  most  frequent  cause  of  periodontitis  ? 
Putrescent  pulp. 

602.  What  is  a  necessary  precedent  of  pulp  putrescence  ? 
Death  of  at  least  a  portion  of  the  pulp. 

603.  What  is  the  first  sign  of  a  devitalized  pulp  ? 

A  slight  change  of  color  and  an  opacity  in  the  crown  of  the 
tooth  ("  clouding  "),  usually  with  gradual  darkening. 

604.  What  is  the  difference  in  the  color  produced  by  putrescent 
pulp  and  that  produced  by  necrosis  ? 

That  from  the  former  is  bluish  or  grayish,  while  that  from  the 
latter  tends  toward  the  yellow  or  bronze-like  color. 

605.  What  time  is  usually  required  for  putrescence  of  a  devital- 
ized pulp? 

Usually  from  one  to  three  years. 

606.  What  is  the  shortest  time  known  ?     The  longest? 
The  shortest,  one  month.     The  longest,  nine  years. 

607.  May  periodontitis  be  caused  by  the  putrescence  of  less  than 
an  entire  pulp  ? 

Unextirpated  portions  of  pulp,  even  in  the  finest  canals,  may 
produce  severe  trouble.  In  multirooted  teeth  a  portion  of  pulp 
may  be  putrescent,  while  other  portions  are  only  dead  or  even 
vital. 

608.  What  is  the  first  indication  in  periodontitis  from  putres- 
cent pulp  ? 

The  venting  of  the  mephitic  gas  evolved. 

609.  How  may  this  be  done  ? 

By  drilling  a  vent  hole  either  through  the  cavity  of  decay,  or 
through  a  filling,  or  at  the  neck  of  the  tooth,  or  in  the  position 
required  for  tap. 


MEMORANDA. 


MEMORANDA. 


PERIODONTITIS.  79 


610.  What  is  a  "vent-hole?" 

An  opening  into  the  pulp  cavity  for  the  escape  of  mephitic  gas. 

611.  How  should  a  vent-hole  be  drilled? 

With  the  least  possible  infliction,  and  in  such  a  position  as  will 
not  weaken  the  tooth,  yet  allow  of  free  access  to  pulp  canals. 

612.  Where  are  vent-holes  usually  drilled  ? 

On  the  incisors  and  cuspids,  disto-labially ;  on  the  first  bicus- 
pids, disto-buccally  ;  on  the  second  bicuspids,  buccally  ;  on  the 
molars,  mesio-buccally. 

613.  How  is  counter-pressure  to  be  applied  for  relief  from 
drilling  ? 

By  either  the  operator  or  the  patient,  by  means  of  thumb  or 
finger.  When  drilling  presses  the  tooth  into  its  socket,  book- 
binders' thread  may  be  knotted  about  the  neck  of  the  tooth,  upon 
which  the  patient  may  exert  the  needed  traction. 

614.  What  should  be  done  after  drilling  vent  ? 

Pass  probe  into  canals,  loosen  the  putrescent  material,  and 
allow  tooth  to  remain  open  a  day  or  two,  as  indicated;  on  no 
account  should  it  be  immediately  closed.     (See  608.) 

615.  What  time  is  required  for  relief  after  drilling  vent  ? 
Usually  from  five  to  fifteen  minutes ;  sometimes  several  hours  ; 

occasionally  no  relief  is  given. 

616.  Why  is  previous  periodontitis  a  cause  of  periodontitis  ? 
The  abnormal  condition  of  peridentium  left  by  previous  perio- 
dontitis predisposes  to  a  recurrence  of  the  disease.     (See  618.) 

617.  Under  what  circumstances  is  this  likely  to  recur  ? 

Tire  of  the  peridentium  from  long-continued  overwork,  or  ady- 
namic, uterine,  enteric  or  other  systemic  complications,  especially 
in  relation  with  pulpless  teeth. 

618.  What  is  taught  of  the  re-establishment  of  comparative 
normality  in  diseased  tissue  ? 

In  proportion  to  the  gravity  of  the  disease  is  a  return  to  com- 
parative normality  rendered  less  possible. 

619.  How  is  peridental  irritation  from  sympathy  with  enteric 
disease  to  be  diagnosed  from  enteric  troubles  caused  by  dental 
disease  ? 

In  the  former  the  dental  trouble  is  usually  a  general  tender- 
ness^ concomitant  with  decided  enteric  difiiculty  ;  in  the  latter  the 


80  DENTAL    PATHOLOGY    AND    THERAPEUTICS. 

dental  difficulty  is  local  and  of  sufficient  length  of  duration  and 
severity  of  infliction  to  cause  general  enteric  trouble. 

620.  What  is  taught  of  the  treatment  in  each  case? 

1st,  refer  enteric  trouble  to  general  practitioner,  and  prescribe 
detergent  and  stimulant  mouth-washes ;  2d,  remove  the  dental 
difficulty. 

621.  Name  some  of  the  other  diseases  of  which  peridental 
irritation  may  be  symptomatic. 

Most  notably :  measles,  mumps,  scarlet  fever  and  diphtheria. 

622.  What  medicine  may  produce  periodontitis  when  applied 
locally  ? 

Arsenic.     (See  460.) 

623.  In  what  manner  does  phosphorus  act  ? 

It  is  not  positively  decided  whether  it  acts  locally  or  system- 
ically ;  but  local  lesions  are  regarded  as  favoring  its  action. 

624.  What  medicines  may  markedly  produce  periodontitis  by 
systemic  action  ? 

Mercurials. 

625.  What  are  the  signs  and  symptoms  of  mercurial  saliva- 
tion ? 

Marked  soreness  of  the  teeth  ;  coppery  taste  in  mouth  ;  general 
peridental  irritation,  accompanied  with  considerable  pain  ;  swelling 
of  the  tongue ;  redness  and  subsequent  whiteness  of  the  gums ; 
constant  flow  of  saliva,  and  marked  fetor  of  the  breath. 

626.  What  connection  have  mercurials  with  loss  of  teeth  ? 
They  destroy  the  peridentium,  causing  exfoliation,  but  have  no 

effect  upon  the  tooth-bone  itself. 

627.  What  are  the  marked  differences  between  phosphor 
necrosis  and  mercurial  necrosis  ? 

Mercurials  produce  death  of  periosteum  and  bone,  causing, 
sometimes,  great  deformity,  while  phosphorus  acts  only  upon  the 
bone,  leaving  the  periosteum  to  restore  the  lost  parts. 

628.  Wha.t  three  species  of  virus  7nay  produce  periodontitis  ? 
Miasmatic,  syphilitic  and  typhoid. 

629.  What  are  the  symptoms  and  signs  of  periodontitis  in 
their  order  of  inception  ? 

Decided  knowledge  of  the  presence  of  the  tooth ;  desire  to 
work  it  with  the  fingers,  tongue  or  antagonizing  tooth ;    marked 


MEMORANDA. 


MEMORANDA. 


PERIODONTITIS.  81 


soreness ;  decided  pain,  together  with  throbbing  of  inflammation  ; 
violent  pain  upon  tapping  not  only  affected  tooth,  but  perhaps 
adjoining  teeth ;  elongation  of  tooth  magnified  to  patient,  with 
concomitant  dull,  persistent  sense  of  weight,  with  sometimes 
fullness  of  tooth ;  continuous  acute  pain ;  redness  of  gums  ;  usually 
complete  obliteration  of  the  health  line. 

630.  What  is  the  health  line? 

The  line  of  demarkation  between  the  pink  and  deep-red  gum 
tissue. 

631.  Under  what  conditions  may  the  health  line  remain 
unchanged  ? 

Usually  in  connection  with  "pulsating  pulps;"  "nodular  calci- 
fication;" "absorption  of  permanent  roots;  "  "circumscribed  or 
apical  exostosis  ;  "  sometimes  with  apical  necrosis  ;  rarely  in  con- 
nection with  uncontrollable  peridental  irritation. 

632.  What  is  the  decisive  symptom  for  peridental  irritation  ? 
Pain  upon  tapping  and  upon  pressure. 

633.  Upon  what  does  the  proper  treatment  of  any  given  case 
of  periodontitis  depend? 

Upon  an  understanding  of  the  grade  of  inflammation  which  is 
existent. 

634.  Into  what  two  forms  is  periodontitis  divided  ? 

1st,  acute,  sthenic,  circumscribed  or  phlegmonous  ;  2d,  chronic, 
asthenic,  diffused  or  erysipelatous. 

635.  Upon  what  do  these  depend  ? 

Upon  length  of  duration,  violence  of  irritation,  temperament 
and  physical  condition.  High-grade  sthenic  patients  of  largely 
nervous,  sanguine  or  bilious  temperament  usually  have  the  acute 
form,  while  asthenic  and  adynamic  patients  of  largely  lymphatic 
temperament  are  more  liable  to  the  chronic  form.  Periodontitis 
lasting  from  one  to  seven  days  is  acute;  after  this  it  is  called 
chronic. 

636.  What  is  the  division  of  the  chronic  form  of  periodontitis  ? 
Benignant  and  malignant. 

637.  What  are  the  two  forms  of  general  treatment  in  perio- 
dontitis ? 

Prophylactic  or  preventive,  and  curative. 


82  DENTAL    PATHOLOGY   AND    THERAPEUTICS. 

638.  What  are  the  two  forms  of  prophylactic  treatment  ? 
Local  and  general. 

639.  What  is  the  local  treatment? 

1st,  removal  of  cause  of  irritation ;  2d,  securing  absolute  rest 
of  the  parts  by  means  of  guards ;  3d,  application  of  tonic, 
astringent,  stimulant,  counter-irritant  or  sedative  remedies,  accord- 
ing to  the  indications. 

640.  What  is  the  general  or  constitutional  treatment  ? 

1st,  regulation  of  diet,  rest  and  exercise;  2d,  according  to  the 
severity  of  the  case,  the  administration  of  a  mild  or  drastic  pur- 
gative for  "  derivation;  "  3d,  systemic  sedation. 

641.  What  are  the  restrictions  as  to  diet,  rest  and  exercise  ? 
The  diet  should  consist  of  food  easy  of  mastication  ;  rest  should 

be  taken  in  a  semi-recumbent  position ;  the  exercise  should  be 
moderate  in  quantity,  avoiding  violent  exertion. 

642.  What  is  the  treatment  for  second-grade  periodontitis? 
Remove  cause ;  apply  guard  for  absolute  rest  of  the  tooth  ;  dry 

gum  and  paint  with  dental  aconite,  protecting  cheek  .by  placing 
a  wad  of  bibulous  paper  over  the  application;  sometimes  slight 
stimulation  (capsicum)  or  support  (iodine)  if  needed.     (See  339.) 

643.  What  is  the  treatment  for  third-grade  periodontitis? 
Remove  cause  with  utmost  gentleness;   secure  absolute  rest  by 

means  of  guards  ;  apply  persistently  tonic,  astringent,  stimulant, 
counter-irritant  or  sedative  local  medication  for  resolution, 
together  with  local  depletion,  if  indicated ;  constant  use  of  cool- 
ing mouth-washes  and  constitutional  treatment. 

644.  What  are  the  various  forms  of  guards? 

The  "gutta-percha,"  the  "rubber  dam,"  the  "H,"  the  "block" 
and  the  "filling"  guards. 

645.  Describe  the  "gutta-percha"  guard. 

Warm  gutta-percha '  base-plate ;  mold  over  lower  teeth  and 
secure  a  comfortable  but  not  close  occlusion  upon  the  upper  sur- 
face of  guard ;  remove  from  mouth ;  slightly  press  so  as  to  make 
guard  "hug"  the  teeth  ;  cool  and  apply.  This  form  of  guard  is 
liable  to  be  bitten  in  pieces  by  nervous  patients. 

646.  Describe  the  "rubber-dam"  guard. 

Fold  rubber  dam  several  thicknesses,  making  a  ribbon  about 
an  inch  in  length;  pass  coarse  needle,  threaded  with  book-binders' 


iMEMORANDA. 


MEMORANDA. 


PERIODONTITIS.  83 


thread,  through  one  side  of  one  end,  then  through  same  side  of 
other  end,  return  through  other  side  of  other  end,  and  other  side 
of  first  end  ;  place  threads  mesially  and  distally  of  selected  tooth 
and  draw  close;  tie  buccally. 

647.  Describe  the  "H"  guard. 

Cut  a  piece  of  silver  or  tin  plate  into  the  form  of  an  H  and 
bend  this  into  the  form  of  a  cap ;  puncture  holes  into  the  lingual 
ends  and  tie  to  tooth  with  book-binders'  thread,  to  prevent  loosening 
of  appliance,  with  danger  of  swallowing. 

648.  Describe  the  "block  "  guard. 

Take  a  piece  of  hard  wood,  one-eighth  of  an  inch  thick,  three- 
eighths  of  an  inch  wide  and  about  a  half  inch  long,  the  ends 
rounded,  and  groove  it  on  the  upper  surface  near  each  end;  drill 
two  holes  through  it  in  each  groove ;  take  a  four-tail  ligature, 
made  by  tying  two  ligatures  in  the  middle  of  each  other;  tie 
around  tooth,  leaving  two  ends  extending  lingually  and  two 
buccally  ;  pass  these  through  their  respective  holes  in  the  guard 
and  knot  firmly  in  each  groove.  The  groove  prevents  the  knots 
from  being  bitten  upon. 

649.  Describe  the  "  filling  "  guards. 

If  practicable,  "  cold  solder"  an  amalgam  guard  to  a  gold  or 
amalgam  filling  upon  the  articulating  face  of  a  tooth,  or  build  up 
a  zinc  phosphate  filling  upon  the  articulating  face  of  any  tooth. 

650.  Where  should  guards  be  placed  ? 

Nearly  all  movable,  tied  and  molded  guards  are  to  be  placed 
on  lower  teeth,  near  the  affected  tooth,  or  occluding  near  it,  if  in 
the  upper  jaw.  Filling  guards  may  be  placed  on  either  side  of 
the  mouth,  according  to  indications. 

651.  Name  the  means  for  local  sedation  by  depletion. 

1st,  lancing  as  for  extraction ;  2d,  the  application  of  two  or 
three  good  leeches  over  a  slight  cut  made  in  the  gum  tissue  adja- 
cent to  the  inflamxcd  part;   3d,  gum  cupping. 

652.  What  medicines  are  to  be  applied  upon  the  gum  to  pro. 
duce  resolution  in  cases  of  third-grade  periodontitis  ? 

As  local  sedatives :  hamamelis,  fluid  extract  of  Jamaica  dog- 
wood, dental  aconite  ;  as  astringents  :  tannin,  tincture  of  krameria 
(applied  by  patient) ;  as  stimulant :  capsicum  bags ;  as  counter- 
irritant  :  dental  iodine  in  spots. 


84  DENTAL    PATHOLOGY    AND    THERAPEUTICS. 

653.  Name  the  medicines  and  remedies  used  in  canals  for  the 
relief  of  severe  periodontitis  with  open  tooth. 

Chloroform  (in  dry  canals),  or  dental  aconite  (guarding  against 
systemic  effect),  covered  with  cotton  dipped  in  cloves  (to  prevent 
absorption  by  the  cotton) ;  acetate  of  morphia  paste,  with  or  with- 
out menthol  or  cocaine ;  or  finely-pulverized  nitrate  of  potassium, 
packed  into  the  moderately-moist  cavity  (melts  after  several  hours 
-and  is  very  cooling) ;  electricity,  and  finally  rapid  drilling  with 
small  dental  trephine  or  spear  drill  through  the  alveolar  process 
into  immediate  proximity  with  the  apex  of  the  root. 

654.  For  what  purpose  is  drilling  resorted  to  ? 
The  release  of  effusions  about  the  apex  of  the  root. 

655.  What  treatment  should  precede  this  ? 

The  obtunding  of  the  parts  with  repeated  and  careful  applica- 
tions of  dental  aconite  or  muriate  of  cocaine,  or  by  the  application 
of  electricity. 

656.  What  medicines  are  used  constitutionally  ? 

For  wakefulness — Preparations  of  opium  and  morphia,  syrup 
of  lactucarium,  hydrate  of  chloral,  bromide  of  potassium  in  large 
doses,  bromidia,  Dover's  powder.  For  sedation — Tartrate  of 
antimony,  squills  or  ipecac  to  slight  nausea,  tincture  of  veratrum 
viride,  tincture  of  aconite  root.  For  systemic  irritability — 
Asafoetida,  valerianate  of  ammonia. 

657.  What  is  the  last  resort  upon  failure  of  local  and  consti- 
tutional means  to  relieve  periodontitis  ? 

Produce  suppuration  by  stimulation. 

658.  What  is  usually  the  first  step  in  treatment  after  the  cure 
of  periodontitis  from  putrescent  pulp  V 

Open  up  tooth;  remove  filaments  of  pulp  with  broaches  or 
hooks,  syringing  frequently  with  tepid  water ;  work  glycerine 
into  canals,  washing  out  and  reapplying  as  often  as  it  discolors ; 
pass  alcohol  into  canals ;  dry  and  disinfect  with  oil  of  cloves, 
€ugenol,  solution  of  permanganate  of  potassium,  solution  of  bichlo- 
ride of  mercury  (1  to  1000)  or  peroxide  of  hydrogen ;  fill  canals 
with  fluid  cosmoline  or  oil  of  cloves ;  dress  with  taper  twists  of 
€otton ;  fill  tap  with  pellet  of  cotton  or  temporary  stopping. 
(See  522.) 


MEMORANDA. 


MEMORANDA. 


PERIODONTITIS.  85 


659.  What  is  taught  of  the  permanence  of  this  stopping,  if 
introduced  without  sensation  ? 

It  is  not  permanent,  but  must  he  removed  for  vent  of  from  five 
to  fifteen  minutes,  if  indicated  by  return  of  soreness. 

660.  How  should  teeth  be  treated  which  will  not  yield  to  the 
action  of  antiseptics? 

By  a  systematic  stopping  and  unstopping  of  the  tooth. 

661.  How  is  this  done  ? 

Stop  for  six  or  eight  hours ;  vent  and  restop  for  fifteen  hours ; 
vent  and  restop  for  twenty-four  hours ;  vent  and  restop  for  forty- 
eight  hours  ;  vent  and  restop  for  seventy-two  hours  ;  then,  if  nO' 
soreness  supervene,  dress  the  canals. 

662.  How  should  teeth  be  treated  which  Avill  not  yield  to- 
systematic  stopping  and  unstopping  ? 

Drill  apical  vent,  or  establish  fistula,  or  fill  with  "vent"  (open- 
ing at  neck  of  tooth). 

663.  What  is  the  basal  principle  upon  which  the  stopping  of 
teeth  depends  ? 

The  gradual  but  uninterrupted  restoration  to  comparative  nor- 
mality of  the  tooth  and  surrounding  parts,  which,  being  open, 
have  been  and  are  yet  in  conditions  of  decided  abnormality. 

664.  How  is  a  tooth  having  a  vital  pulp  left  after  the  cure  of 
periodontitis  ? 

In  a  condition  practically  normal. 

QQ^.  How  is  a  tooth  left  after  the  cure  of  periodontitis  from 
putrescent  pulp  or  protruding  filling  material  ? 

Pathological,  because  of  its  pulpless  and  open  condition. 

QQQ.  How  is  suppuration  induced  in  fourth-grade  periodontitis  ? 

In  sensitive  patients  make  vent  and  sedate  gum  with  mild 
medicaments,  as  hamamelis  (use  no  strong  sedatives,  as  aconite);, 
when  pain  is  endurable  apply  pepper  bag ;  loosely  stop  the  vent 
and  unstop  as  the  pain  becomes  unendurable ;  if  liable  to  pain, 
unstop  at  night.  The  pepper  bag  should  be  removed  during 
eating  and  sleeping.  If  stopping  pains,  owing  to  effusions,  draw 
out  effusions  by  absorbent  cotton  and  restop.  Medicate  systemi- 
cally.  (See  656.)  Cooling  applications  only  are  indicated  for 
external  medication.  In  less  sensitive  patients  less  frequent 
stopping  and  unstopping  is  required. 


86  DENTAL    PATHOLOGY    AND    THERAPEUTICS. 

667.  What  complications  render  the  chronic  form  of  periodon- 
titis more  difficult  of  treatment? 

Temperament  (generally  largely  lymphatic)  and  adynamic, 
asthenic,  systemic  conditions,  producing  structural  changes,  effu- 
sions, tendency  to  caries  and  sanious  pus. 

668.  What  is  the  local  treatment  ? 

A  mingling  of  stimulant  (pepper  bags  for  resolution),  astrin- 
gent (tannin)  or  sorhefacient  (iodine)  applications,  according  to 
the  condition  and  recuperative  energy  of  the  patient.  Place 
filling  guard  on  opposite  side  of  mouth,  to  allow  tooth  to  do  a 
little  work ;  make  soothing  (cold  water,  vinegar  and  water,  or 
hamamelis)  or  astringent  (tannin  and  water,  alum  water)  or 
sorhefacient  (officinal  iodide  of  potassium  ointment)  applications 
to  outside  of  face. 

669.  What  is  the  systemic  treatment? 

Good  nutritious  food ;   tonic  medication  ;   no  purgatives. 

670.  What  is  the  principle  underlying  the  treatment  of  chronic 
periodontitis  ? 

A  deliberate  restoration  to  normality,  in  view  of  previous  delib- 
erate and  continued  deviation. 

671.  What  are  the  results  of  chronic  periodontitis  ? 

Watery  effusions  and  indurations,  either  easy  or  difficult  of 
discussion  ;  oedema  of  lip  and  cheek ;  fetid  breath ;  inspissated 
saliva. 

672.  What  is  the  treatment  for  watery  effusions  ? 

R  Tincture  of  arnica,      -i 

rr,.     ,  t,  ■  >  Equal  parts. 

Tincture  of  capsicum,  J     ^       ^ 

Dilute  sufficiently  and  apply  on  cloths  to  outside  of  face. 

Or, 

Iodide  of  potassium,  ^i. 

Simple  Ointment,  §i. 

Liquor  of  potassa,  gtt.  iii. 

Eub  on  outside  of  face,  about  the  part  affected. 

673.  What  is  the  treatment  for  indurations? 

Dental  iodide  of  potassium  ointment,  applied  two  or  three 
times  a  day. 

674.  What  is  the  treatment  for  the  fetid  condition  of   the 

mouth  ? 

Eau  de  cologne,  1  part. 
Alcohol,  3  parts. 
One-half  teaspoonful  to  glass  of  water  as  mouth- wash. 


MEMOEA]SrDy\. 


MEMORANDA. 


ALVEOLAR   ABSCESS.  87 


675.  What  is  the  treatment  if  resolution  be  impracticable? 
Produce  suppuration  by  stimulating  continuously   all  patient 

•can  comfortably  bear. 

676.  What  is   the  time   required  to  produce  suppuration   in 
these  cases? 

From  four  to  seven  days — perhaps  longer. 

677.  What  form  of  disease  is  established  by  the  termination  of 
periodontitis  in  suppuration  ? 

Alveolar  abscess  ? 

678.  What  is  the  line  of  distinction  between  periodontitis  and 
alveolar  abscess  ? 

As  soon  as  the  least  pus  is  formed  periodontitis  ends  and  alveo- 
lar abscess  begins. 


ALA^EOLAR  ABSCESS. 

679.  What  is  an  alveolar  abscess? 

A  cavity  containing  pus,  having  its  incipiency  between  the 
•external  and  internal  alveolar  plates. 

680.  What  are  the  six  causes  for  alveolar  abscess? 

1st,  putrescent  pulp;  2d,  tartar;  3d,  a  necrosed  tooth  or  root; 
4th,  carious  bone ;  5th,  necrosed  bone ;  6th,  foreign  materials 
(splinters,  bristles,  filling  material  protruding  through  apical 
foramen,  or  perforation,  broken  probes,  etc.). 

681.  How  is  a  tooth  having  a  vital  pulp  left  after  the  cure  of 
alveolar  abscess? 

In  such  a  condition  as  permits  a  natural  return  to  comparative 
normality. 

682.  How  is  a  tooth  left  after  the  cure  of  alveolar  abscess  from 
putrescent  pulp  or  protruding  filling  material  ? 

In  such  a  condition  as,  by  subsequent  treatment,  may  permit  a 
return  to  comparative  normality. 

683.  What  is  the  usual  location  of  an  abscess  from  putrescent 
pulp  ? 

At  the  apex  of  root  of  the  tooth.  In  multirooted  teeth  some- 
times found  in  the  bifurcation  or  between  the  roots. 


DENTAL    PATHOLOGY    AND    THERAPEUTICS. 


684.  What  are  the  two  kinds  of  alveolar  abscess  ? 
Acute  and  chronic. 

685.  To  what  do  the  terms  acute  and  chronic  refer  ? 
To  length  of  duration.     (See  86.) 

686.  What  are  the  local  signs  and  symptoms  of  acute  alveolar 
abscess  ? 

Violent  throbbing  pain,  redness,  heat,  tension  and  swelling, 
with  subsequent  fluctuation,  lasting  from  ten  hours  to  three  or 
four  days,  until  the  evacuation  of  pus,  when  only  swelling  remains. 
If  from  putrescent  pulp,  sense  of  fullness  in  the  tooth. 

687.  What  are  the  general  signs  and  symptoms  of  acute  alveo- 
lar abscess  ? 

Fever,  with  accompanying  hot,  dry  skin,  coated  tongue,  con- 
stipation, prostration,  violent  pain  shooting  through  neck  and  face. 

688.  What  are  the  signs  and  symptoms  of  chronic  alveolar 
abscess  ? 

A  change  in  character  or  long  continuance  of  the  acute ;  or 
from  the  first  less  violent  but  more  extended  manifestations ;  pain 
usually  less  violent,  but  more  enervating ;  discoloration  more 
diffused ;  oedema  more  extended ;  tendency  of  pus  to  infiltrate 
into  surrounding  tissues,  especially  in  persons  of  strumous- 
diathesis  ;  gradual  cessation  of  these  signs  and  ■  symptoms  upon 
establishment  of  fistula. 

689.  In  what  ways  may  an  abscess  discharge  its  pus  ? 

1st,  through  the  external  or  internal  alveolar  plate  and  covering 
tissues  into  the  mouth,  usually  distally  from  affected  root ;  2d,, 
through  the  apical  foramen,  canal  and  crown  of  tooth  ;  3d,  at  free 
edge  of  gum,  between  root  of  tooth  and  surrounding  process  ;  4th, 
through  antrum  and  meatus  into  nostril  on  side  of  lesion ;  5th, 
from  upper  jaw,  internally  into  pharynx  or  externally  through 
cheek  ;.  6th,  from  lower  jaw,  externally,  either  facially  or  cervically. 

690.  What  is  the  prognosis  as  regards  saving  of  tooth  in  con- 
nection with  single-rooted  teeth  ? 

Usually  favorable,  excepting  occasionally  upper  laterals  and 
more  frequently  lower  bicuspids. 

691.  What  is  the  prognosis  in  connection  with  multirooted  teeth? 
Usually  favorable,  excepting  lower  third  molars  and  teetji  with 

external  fistulse. 


MEMORANDA. 


MEMORANDA. 


ALVEOLAR    ABSCESS.  89 


692.  What  are  the  possible  sequelae  of  alveolar  abscess? 

Continuous  suppuration,  indurations,  growths,  necrosis  of  por- 
tion of  maxilla,  facial  neuralgia,  otalgia,  cophosis,  ophthalmalgia, 
amaurosis,  cephalalgia  and  even  py8emia  and  tetanus. 

693.  What  are  the  two  forms  of  treatment  of  alveolar  abscess  ? 
Palliative  and  curative. 

694.  What  is  the  palliative  treatment  ? 

The  promotion  of  free  suppuration,  the  induction  of  pointing 
and  the  establishment  of  a  fistula  in  the  manner  most  acceptable 
to  the  patient.     (See  666.) 

695.  What  are  the  means  of  curative  treatment  ? 

1st,  treatment  of  tooth,  either  with  or  without  a  fistulous  open- 
ing ;  2d,  extraction  of  tooth  or  root  if  not  valuable  or  the  disease 
be  otherwise  incurable. 

696.  What  is  the  difference  in  treatment  of  abscess  from 
putrescent  pulp  with  fistulous  opening  and  without  ? 

With  a  fistulous  opening. — EiFect  free  entrance  ;  thoroughly 
cleanse  and  disinfect  canals  (see  658),  not  forcing  medica- 
ment through  apical  foramen ;  dress  roots  permanently  and  fill 
tooth;  allow  several  weeks  for  natural  healing  of  fistula.  If  this 
does  not  occur,  inject  with  detergents,  astringents  or  stimulants, 
as  indicated  : 


Salt  and  water. 

Solution  of  chloride   of  zinc 


Tincture  of  calendula. 
Solution  of  Calvert's  carbolic 


(zinc,  5  grs. ;   water,  1  oz.).  ;  acid    (acid,  20   to  60    grs. ; 

Phenol  sodique.  i  water,  1  oz.). 

Solution  of  sulphate  of  zinc  |  Iodide  of  zinc  (deliquesced). 

(zinc,  5  grs.;  water,  1  oz.).  Dilute  sulphuric  acid  (acid,  1 

Solution  of  alum  (saturated),  i  part;  water,  3  parts). 

Without  fistulous  oipening. — Open  tooth;  cleanse  canals;  evac- 
uate pus  through  canal  if  possible  ;  disinfect  tooth  ;  leave  open  or 
loosely  stopped  from  one  to  three  days,  in  view  of  continued  pus 
formation ;  this  will  determine  whether  the  vent  is  a  sufficient 
relief  for  the  abscess.  If  symptoms  do  not  return,  disinfect  canal 
again  and  proceed  as  in  periodontitis  from  putrescent  pulp,  either 
by  the  antiseptic  method  or  by  the  systematic  stopping  and  unstop- 
ping of  the  tooth,  recognizing  the  additional  concomitant  of  irri- 
tation from  the  presence  of  pus.  If  symptoms  of  abscess  return 
after  leaving  tooth  open,  a  fistula  must  be  established. 


90  DENTAL    PATHOLOaY    AND    THERAPEUTICS. 

697.  What  are  the  three  methods  of  establishing  a  fistula? 
1st,  by  closing    canals  and    stimulating  to    suppuration    (see 

666) ;  2d,  by  lancing  through  the  tissue  ;  3d,  by  drilling  through 
alveolar  process  to  apex  of  root.     (See  653-655.) 

698.  What  is  the  method  of  ascertaining  upon  which  root  of  a 
multirooted  tooth  an  abscess  is  located  ? 

Pressure  upon  the  crown  in  the  direction  of  the  root  aifected  will 
usually  produce  greater  response  than  pressure  in  other  directions. 

699.  What  is  taught  regarding  the  diagnosis  of  abscess  in  the 
bifurcation  of  roots  ? 

This  most  frequently  pertains  to  lower  molars.  Its  diagnosis  is 
only  inferential,  based  upon  continued  pus  formation  and  apparent 
inability  to  reach  seat  of  disease  by  free  canal  openings. 

700.  What  is  the  treatment  ? 

Drilling  through  the  cementum  from  the  pulp  cavity  directly 
upon  the  abscess. 

701.  What  is  the  last  resort? 
Extraction. 

702.  Name  the  medicaments  recommended  for  introduction 
into  canals  as  permanent  dressing  in  cases  of  abscess. 

Acetate  of  morphia  paste,  with  or  without  menthol,  oil  of  cloves, 
eugenol,  oils  of  cajeput  and  eucalyptus,  fluid  or  viscid  cosmoline, 
inspissated  canal  dressing,  or,  as  a  last  resort,  iodoform  paste. 

703.  What  is  the  treatment  for  abscess  in  the  upper  jaw,  with 
external  fistula  ? 

Establish  internal  fistula  and  subsequently  either  treat  or 
remove  the  tooth  or  root. 

704.  What  is  the  treatment  for  abscess  in  the  lower  jaw,  with 
external  pointing  ? 

Lance  freely  and  evacuate  the  pus  through  the  gum  tissue,  even 
though  the  abscess  be  ready  to  discharge  externally ;  support 
externally  with  bandage  and  compress,  using  the  latter  as  a  means 
for  cooling  applications ;  stimulate  internally  until  an  internal 
fistula  is  established ;  then  extract  the  tooth. 

705.  What  is  the  danger  in  cases  of  abscess  in  the  lower  jaw, 
with  external  fistula  ? 

Unsightly  scar,  which  is  always  consequent  upon  the  extraction 
of  the  tooth  prior  to  the  establishment  of  an  internal  fistula. 


MEMORANDA. 


MEMORAlSrDA. 


CARIES    AND    NECROSIS.  91 

706.  What  is  the  method  of  preventing  unsightly  scar  in  such 
places  as  would  be  plainly  visible  in  females  and  beardless  males  ? 

Thoroughly  establish  a  new  fistula  beneath  the  rim  of  the  jaw 
by  drawing  up  the  tissues,  puncturing  them  and  drawing  a  seton 
through  from  the  old  fistula  to  the  new  one ;  this  seton  should  be 
gradually  withdrawn  through  the  new  fistula  as  the  old  fistula 
heals  ;  after  new  fistula  is  thoroughly  established  and  old  fistula 
is  thoroughly  healed,  extract  tooth. 

707.  What  subsequent  precaution  should  be  observed  in  cases 
with  external  fistulse  successfully  treated  without  removal  of 
tooth  ? 

To  extract  tooth  upon  the  slightest  recurrence  of  peridental 
irritation. 

708.  What  is  the  treatment  after  extraction  for  alveolar 
abscess  ? 

If  the  sac  be  removed  with  the  tooth,  only  that  treatment  is 
needed  which  will  insure  the  closing  of  the  alveolus;  but  if  not 
removed,  obliterate  the  sac  with  hoe-shaped  excavator. 


CARIES   AND   NECROSIS. 

709.  How  is  the  diagnosis  of  carious  bone  made? 

By  means  of   a  chisel-pointed  probe.     A  soft,  honey-combed 
condition  is  found. 

710.  What  is  the  treatment  ? 
Remove  the  carious  bone. 

711.  How  is  necrosis  of  alveolar  process  diagnosed  ? 

By  peculiar  feel  of  hardness  and  smoothness  under  instrument 
and  the  marked  bluish,  glazed  appearance  of  the  gum. 

712.  How  does  caries  of  the  walls  of  an  alveolus  sometimes 


occur 


Through  lack  of  covering  by  granulations. 
713.  What  is  the  treatment  ? 

Bur  out  the  process  till  a  surface  capable  of  healthy  granula- 
tion is  reached.     Strengthen  clot  by  astringent  applications. 


92  DENTAL    PATHOLOGY    AND    THERAPEUTICS. 

714.  What  lesions  may  a  dead  tooth  occasion  ? 

An  almost  endless  variety  of  local,  facial,  antral,  nasal,  oph- 
thalmic, otic,  cerebral,  muscular  and  even  systemic  complications. 
{See  429.) 

715.  How  is  the  diagnosis  of  a  portion  of  root  within  the  alve- 
olus made  ? 

With  the  instrument  used  for  diagnosing  carious  bone.  A 
■characteristic  sound  and  feel  is  produced  upon  scratching  and 
touching. 


PYORRHCEA   ALVEOLARIS. 

716.  What  is  pyorrhoea  alveolaris  ? 

A  more  or  less  general  formation  of  pus  about  the  roots  of  the 
teeth  exuding  from  beneath  the  free  edges  of  the  gums. 

717.  What  is  its  cause  ? 

Systemic  predisposition,  combined  with  decided  induration  of 
tooth  tissue  or  other  local  irritant  (sanguinary  calculus,  caries  or 
necrosis  of  process  edge,  gum  pouches). 

718.  What  is  its  treatment  ? 

If  possible,  thorough  removal  of  all  local  possibilities  for  irrita- 
tion, together  with  astringent,  detergent  and  stimulant  medica- 
tion (zinc  chloride,  zinc  iodide,  carbolic  acid  and  caustic  potassa, 
■dilute  sulphuric  acid,  peroxide  of  hydrogen). 

719.  What  is  the  prognosis  ? 

Possible  amelioration  of  greater  or  less  length  of  duration  ; 
probable  recurrence  of  trouble,  with  usually  gradual  but  persistent 
re-establishment  of  previous  condition. 


MEMOKAXDA. 


MEMORANDA. 


MEDICAMENTS. 


Aconite  Root,  Tincture  of. — (Officinal.)  Systemic  dose, 
three  to  five  drops.      Sedating  to  the  nervous  system. 

Aconite,  Dental    Tincture    of. — (Four  times  strength  of 

officinal.) 

R   Tincture  of  aconite  root,  5!. 

Place  in  wide-mouthed  bottle  ;  mark  bottle  one-fourth  way  up ; 
evaporate  to  mark.     Systemic  dose,  one  drop. 

Uses. — Powerful  sedative  and  pain  obtundent ;  used  with  ace- 
tate cf  morphia  when  needed ;  is  a  local  anaesthetic.  Very  great 
care  must  be  observed  in  its  use. 

Aconite,  Laudanum  and  Cliloroform. — See  Laudanum. 

Aconitia  Ointment. — Avoid  mouth  and  eyes. 

R   Aconitia,  gr.  ii. 
Simple  cerate,  5  i. 

Mix  with  spatula  on  druggist's  slab,  thus  :  Rub  up  the  aconitia 
with  a  small  portion  of  cerate;  soften  with  three  or  four  drops  of 
oil  of  cloves ;  add  the  balance  of  the  cerate,  a  little  at  a  time ; 
spatulate  briskly  and  thoroughly  for  twenty  minutes. 

Uses. — Applied  externally  for  relieving  stiffness  of  jaws, 
neuralgic  trouble,  soreness  of  throat ;  rubbed  on  the  skin  over  the 
part  affected.  A  drop  of  oil  of  cloves  softens  the  ointment  for 
application,  if  needed.  Apply  from  tip  of  little  finger  for  gentle- 
ness.    (Powerful  poison.) 

Alcohol,  95  Per  Cent. — (Not  Druggists'.) 
Uses. — Cleanser  for  canals  and  cavities  ;    deodorizer ;    drier 
for  cavities ;  for  making  solutions  and  for  burning. 

(93) 


94  DENTAL    PATHOLOGY   AND    THERAPEUTICS. 

Alum. 

Uses. — Saturated  solution  for  syringing  abscesses ;  weaker 
solution  for  astringent  mouth-wash  in  edentulous  mouths. 

Ammonium,  Carbonate  of. — In  quarter-grain  doses  is  used 
in  systemic  treatment  for  sensitive  dentine. 

Antimony  and  Potassium,  Tartrate  of. — See  Tartrate. 

Arnica,  Tincture  of. — Combined  with  water,  one-half  tea- 
spoonful  to  glass  of  water,  is  especially  indicated  in  cases  of 
soreness  from  swelling ;  may  be  used  in  the  mouth. 

Arnica  and  Laudanum. — See  Laudanum. 

Arsenical  Pastes. 

R  Arsenions  oxide,  gr.  v. 
Acetate  of  morphia,  gr.  x. 

Mull  in  mortar ;  moisten  cotton  pellet  in  either  oil  of  cloves, 

eugenol,  oily  carbolic  acid  or  dental  aconite,  and  dip  into  powder. 

R  Arsenious  oxide,  gr.  v. 
Acetate  of  morphia,  gr.  x. 
Either  oil  of  cloves,  eugenol,  oily  carbolic 
acid  or  dental  aconite,  gtt.  x. 

These  separate  on  standing,  as  follows : 

Carbolic  acid,  cloves,  etc.,    .     .     top  layer. 
Acetate  of  morphia,  ....     middle  layer. 
Arsenious  oxide, bottom  layer. 

Therefore  must  stir  paste  before  using. 

R  Arsenious  oxide,  gr.  v. 
Acetate  of  morphia,  gr.  x. 
Viscid  cosmoline,  q.  p.,  to  buttery  paste. 

Does  not  separate. 

R  Arsenious  oxide,        \ 

Acetate  of  morphia,  >-  aa.  gr.  v. 

Muriate  of  cocaine,  J 

Oil  of  cloves,  q.  s.,  to  paste. 

Arsenical  Devitalizing  Fibre. 

R  Absorbent  cotton  (cross-cut  fine). 
Arsenious  oxide,  gr.  v. 
Acetate  of  morphia,  gr.  x. 
Oily  carbolic  acid,  q.  s.,  to  very  thin  paste ; 
saturate  cotton  with  paste  and  dry. 

Used  in  places  where  pastes  would  be  dangerous  from  leakage. 


MEMORANDA. 


MEMORANDA. 


MEDICAMENTS.  95 


Asafoetida. — Pills  of  two  grains  each.  Used  as  internal  stim- 
ulant when  suffering,  or  in  nervousness  or  irritability  from  loss 
of  sleep;  in  weakness  and  faintness;  useful  for  reduction  of 
sensitivity. 

Benzoin,  Tincture  of. — Pulp  soother ;  leaves  gummy  re- 
siduum at  bottom  of  cavity  ;  used  instead  of  sandarac  for  gumming 
cottons  in  cases  of  pulpitis  ;  useful  in  mouth-washes,  given  after 
■extraction ;  used  in  soaps  and  in  making  benzoated  cerate. 

Benzoated  Cerate. 

R  Simple  cerate,  ^  i. 
Tincture  benzoin,   Ji. 

Used    in    making    the    red    precipitate    ointment;    prevents 

spoiling. 

Cajeput  and  Eucalyptus. 

Oil  of  cajeput,        |  Alternates. 
Oil  of  eucalyptus,  -• 

Antiseptics  and  pain  obtundents  ;  used  in  canals  and  in  devital- 
izing pulps  of  deciduous  teeth. 

Calendula,  Tincture  of. — Excellent  stimulant  to  recupera- 
tion ;  a  few  drops  in  a  half  tumbler  of  water  excellent  as  collu- 
torium. 

Camphor,  Spirits  of. — Preferred  by  some  persons  to 
cologne ;  also  useful  in  pulpitis. 

Capsicum,  Tincture  of. — Stimulant ;  painted  on  gums  ; 
diluted  according  to  the  ability  of  patient  to  endure ;  does  not 
vesicate ;  diluted,  makes  a  good  stimulating  injection. 

Capsicum  Bags  ("Pepper  Bags"). — Made  by  sewing  a  thick- 
ness of  muslin  (f  in.  x  f  in.)  and  of  thin  rubber  cloth  together 
on  three  sides,  filling  with  ground  capsicum  or  ground  capsicum 
and  ground  ginger  (equal  parts),  and  sewing  up  the  fourth  side. 
Useful  for  resolving  incipient  periodontitis  (see  99),  stimulating 
to  suppuration  when  indicated,  and  hastening  ulceration  in 
alveolar  abscess. 

Directions  for  Use. — Before  applying  the  pepper  bag  it 
should  be  soaked  a  few  minutes    in  water — five  or  ten — when 


96  DENTAL   PATHOLOGY   AND    THERAPEUTICS. 

it  should  be  placed  upon  the  gum  over  the  sore  tooth,  with  the  mus- 
lin side  against  the  gum  and  the  rubber  cloth  against  the  cheek. 

This  prevents  the  pepper  from  too  severely  irritating  the  cheek, 
and  secures  increased  irritation  at  the  place  where  it  is  desired. 

It  sometimes  happens  that  the  "burning"  of  the  pepper  bag 
is  too  intense,  even  with  the  precaution  of  the  soaking.  Should 
this  be,  it  will  be  rendered  more  tolerable  by  removing  the  bag, 
washing  it  off  in  cool  water,  and  rinsing  out  the  mouth,  and  then 
replacing  the  bag.  It  is  sometimes  necessary  to  repeat  this 
washing  and  rinsing  operation  two  or  three  times,  but  this  is  very 
unusual. 

When  the  pepper  bag  has  been  made  acceptable,  it  should  be 
worn  constantly^  except  while  eating  or  sleeping. 

After  it  has  been  worn  for  some  days,  and,  indeed,  when  it  has 
apparently  lost  all  its  strength,  it  must  not  he  regarded  as  worth- 
less, for  it  is  then  in  the  very  best  condition  to  produce  excellent 
results. 

If  these  seemingly  worthless  pepper  bags  were  dried  and  then 
tested  with  the  tongue,  they  would  be  recognized  as  possessing 
quite  enough  taste  of  capsicum  to  insure  sufficient  irritation  for 
all  practical  purposes. 

It  is,  therefore,  only  very  exceptionally  needful  to  use  more 
than  one  pepper  bag  in  any  given  case. 

Carlbolic  Acid,  Calvert's  (crystals). — Used  when  solubil- 
ity of  the  acid  is  desired  ;  in  solution  is  an  excellent  stimulant 
injection  for  fistulas.     (See  696.) 

Carbolic  Acid,  Oily  ("Merck's  Creasote  "). — Darkens  in 
color  with  age,  but  not  spoiled ;  obtundent  of  sensitive  dentine ; 
obtundent  in  pulpitis ;  escharotic ;  antiseptic ;  never  to  be  used 
in  canals  or  as  obtundent  in  deep-seated  caries,  unless  devital- 
izing ;  used  for  saturating  crown  dentine  in  pulpless  teeth  of 
very  poor  structure  ;  used  for  carbolic  acid  soap. 

Cerate,  Benzoated. — See  Benzoated. 

Cerate,  Simple. 

R  Lard,  2  parts. 
White  wax,  1  part. 

Keep    in    porcelain  jar.       Used    for   making    ointments    and 

anointing  stoppers. 


MEMORANDA. 


MEMORANDA. 


MEDICAMENTS.  97 


Clialk,  Prepared. — (The  same  article  as  precipitated  chalk, 
but  in  lump  form.)  Is  alkaline;  used  for  sensitive  dentine;  the 
lump  form  prevents  its  being  blown  away  by  breath ;  neutralizes 
the  acids  used  for  sensitive  dentine ;  also  acids  of  mouth  (see  172); 
its  daily  judicious  use  reduces  sensitivity  of  dentine. 

Clienopodiuni  Album,  Tincture  of. — (Not  officinal.) 
Styptic  and  haemostatic  for  light-haired  patients. 

R   Leaves  of  chenopodium  album  (lambsquarters). 
95  per  cent,  alcoliol,  q.-  s. 

Gather  leaves  when  flowers  are  in  bud. 

Dose. — For  active  hemorrhage — One  drop  each  minute  in  tea- 
spoonful  of  water  for  five  to  forty-five  minutes.  For  hemorrhagic 
oozing — Two  or  three  drops  every  five  or  fifteen  minutes,  as  indi- 
cated. As  preventive  to  hemorrhage  in  hemorrhagic  diathesis — 
Three  to  five  drops  three  to  five  times  a  day  for  a  week. 

Cliloral  Hydrate. 

R   Hydrate  of  chloral,   3  iii. 
Water,  ^i. 

Used  after  tannin  No.  2  as  pain  obtundent ;    use  with   care ; 

irritating  to  mucous  membrane  and  epithelium. 

Cliloroforui. — Local  or  general  anaesthetic,  and  justly  accord- 
ed to  be  the  most  dangerous. 

Cmnamon,  Oil  of  (Chinese). — Alternate  to  oil  of  cloves. 

Cloves,  Oil  of. — Pain  obtundent,  stimulant,  antiseptic  and 
odorizer.  Used  for  moderately  persistent  obtunding  of  sensitive 
dentine ;  soothing  of  pulp  ;  for  canal  dressings  ;  to  prevent  sore- 
ness of  gum  in  separating  teeth  and  in  pelleting  ingrowing  gum ; 
ingredient  in  pastes  and  sandarac  varnish. 

Cocaine,  Muriate  of  (crystals). — Used  in  sensitive  dentine; 
with  acetate  of  morphia  paste;  as  pain  obtundent;  as  local 
ansBsthetic. 

Cologne,  Eau  de. — (Should  contain  little  or  no  rosemary, 
which  is  bitter.)  Used  as  stimulant  in  cases  of  faintness  or  weak- 
ness ;  as  odorizer  for  mouth  in  putrescent  pulp,  tartar  and 
extractinof  cases:   also  odorizer  for  office. 


98  DENTAL    PATHOLOGY   AND    THERAPEUTICS. 

Cosmoline,  Fluid. — Emollient;  permanent  antiseptic.  Used 
as  a  vehicle  in  pastes  ;  is  a  valuable  canal  medicament;  is  usuallAT 
combined  with  menthol. 

Cosmoline,  Viscid.— Useful  as  permanent  canal  dressing. 

Erig-eron    Canadeuse,  Tincture    of   (Fleabane). — Styptie 

and  haemostatic  for  dark-haired  patients. 

R   Erigeron  Canadense  (leaves). 
95  per  cent,  alcohol,  q.  s. 

Uses  and  doses  same  as  of  chenopodium  album. 

Eucalyptus. — See  Cajeput. 

Eug-enol. — The  active  principle  of  the  oil  of  cloves.  Very- 
powerful  pain  obtundent. 

Glycerine. — Used  in  canals ;  antiseptic  and  detergent;  is  not 
durable,  because  of  solubility;  absorbs  water  from  dentine; 
soothes  pain  from  carbolic  acid  ;  solvent  in  making  medicaments. 

Hamamelis. — Pond's  or  Humphrey's  Extract  of  Hama- 
melis  Virginica  (Witch  Hazel).  Reliable  antiphlogistic;  useful 
in  peridental  trouble  ;  to  be  used  by  patients  diluted  ;  a  teaspoon- 
ful  to  a  half  tumbler  of  water;  or  full  strength  on  pads  over  gum; 
or  for  syringing  fistulse  ;  or  for  oedematous  conditions  externally; 
especially  adapted  to  irritation  of  mucous  membranes. 

Hop  Pillow. — (Dry  hops  in  small  pilloAV-case.)  Useful  as 
systemic  soother. 

Hop  Poultice.— (Hops  moistened  with  hot  water,  made  of 
convenient  size  and  applied  for  neuralgia  or  other  facial  compli- 
cation.) The  only  hot  external  application  which  is  ever  permis- 
sible in  cases  of  alveolar  abscess. 

Hops,  Strong-  Infusion  of. — Soothing  external  application. 
Hypodermic  Injection. — See  Morphia. 

Inspissated  Canal  Dressing. 

R   Acetate  of  morphia,  gr.  x. 
Sulphite  of  lime,  gr.  x. 
Fluid  cosmoline,  q.  s.,  to  a  thick  paste. 


MEMORANDA. 


MEMORANDA. 


^^0      f!/Y'. 


MEDICAMENTS.  99 


The  portion  used  is  softened  with  a  crystal  of  menthol  (for 
cooling).  In  canals  is  soothing,  antiseptic,  unchangeable  and  easy 
of  removal  in  case  of  future  trouble. 

Iodine,  Dental  Tincture  of. 

R  Iodine,    ^iii. 
Alcohol,   ^  i. 

Dissolve  iodine  by  frequent  daily  shaking  for  a  week  or  two. 
Used  on  gums  as  counter-irritant  after  capping,  or  in  periodon- 
titis ;  also  acts  as  sorbefacient ;  is  used  in  devitalization  of  decidu- 
ous pulps.     Use  in  small  quantity  with  great  care. 

Iodoform  Paste. 

R  Iodoform  crystals,  gr.  xx. 
Fluid  cosmoline,  gtt.  x. 
Oil  of  cinnamon,  gtt.  ss. 

Used  as  last  resort  in  pulp  soothing  or  capping,  or  in  canals. 

Ipecacvianlia,  Syrup  of. — Systemic  sedative.  Use  same  as 
of  tartrate  of  antimony  or  lobelia. 

Dose. — Two  or  three  drops  every  half  hour,  ad  nauseam. 

Krameria,  Tincture  of. — Used  for  its  astringent  and  color- 
ing qualities  in  mouth-washes. 

liactucarium,  Syrup  of. — (Should  be  well  made.)  Produces 
natural  rest,  if  not  sleep,  by  quieting  the  nervous  system. 

Dose. — A  teaspoonful  to  a  dessertspoonful  every  half  hour,  if 
needed. 

Liaudanum. — Pulp  soother;  antiphlogistic.  Used  in  combina- 
tion with  arnica  in  mild  periodontitis  ;  narcotic  when  taken  inter- 
nally.    Systemic  dose,  twenty  to  twenty-five  drops. 

Liaudanum,  Aconite  and  Chloroform. 

R  Laudanum,  ^ 

Tincture  of  aconite  (ofi&cinal),    [  Equal  parts. 
Chloroform,  J 

Used  as  a  substitute  for  aconitia  ointment,  especially  in  cases 
of  neuralgic  trouble  from  pathological  eruption  of  lower  wisdoms. 


100  DENTAL   PATHOLOGY   AND   THERAPEUTICS. 

!Laudanuin  and  Arnica. 

R  TiDCture  of  arnica,  |  j,^^^^  ^^^^^ 
Laudanum,  J 

Or, 

R  Tincture  of  arnica,  |  Equal  parts. 

Bimeconate  of  morphia,   > 

Are  alternates.  Used  in  cases  of  mild  peridental  trouble,  on 
muslin  pads,  over  aiFected  tooth.     May  swallow  the  saliva. 

Licad  Water  and  Laudanum. 

R  Acetate  of  lead,  3  i. 
Laudanum,  §i. 
Water,  Oi. 

Antiphlogistic  for  external  application. 

Liime  Water. — Place  a  lump  of  unslacked  lime  in  a  bottle  of 
water,  making  a  saturated. solution.  Useful  in  sensitive  dentine, 
both  locally  and  systemically.  As  solution  is  used,  add  more 
water  indefinitely. 

Lobelia,  Tincture  of. — Alternate   to  tartrate  of  antimony. 
Dose. — Two  or  three  drops  every  three  or  four  hours,  to  slight 
nausea. 

Mentliol  (crystals). — Cooling ;  soothing.  Used  with  acetate  of 
morphia  paste  or  inspissated  canal  dressing,  or  other  medicaments, 
when  its  qualities  are  needed.  It  softens  the  paste.  Mixed  with 
paraffine  or  spermaceti,  is  usedacZ  libitum  for  soreness  of  jaw  and 
neuralgia. 

Mercury,  BicMoride  of. — (Diluted,  1  to  1000.) — Is  an  excel- 
lent disinfectant  for  canals.   Use  with  care.  Has  disagreeable  taste. 

Morpliia,  Acetate  of. — Used  in  acetate  of  morphia  paste ; 
in  arsenical  paste  ;  in  inspissated  canal  dressing. 

Morpliia,  Bimeconate  of  (Solution). — (Solution  of  same 
strength  as  laudanum.)  A  good  make  will  remain  clear ;  alternates 
with  opium  and  morphia  administrations,  being  especially  indi- 
cated in  nervo-bilious  and  bilio-nervous  temperaments. 

Dose. — A  half  teaspoonful,  pro  re  natd. 


MEMORANDA. 


MEMORANDA. 


MEDICAMENTS.  101 


Morpliia,  Hypodermic  Injection  of. — For  sensitive  den- 
tine. Dissolve  in  water  hypodermic  pellet  containing  sulphate 
of  morphia,  |  gr.;  sulphate  of  atropia,  -j^  gr.,  and  inject  into  arm. 


Morpliia  Paste,  Acetate  of. 

R  Acetate  of  morpliia. 

Oil  of  cloves,  q.s.,  to  make  paste. 

Pain  obtundent.  A  portion  of  this  is  used  alone  or  with  menthol 
(a  crystal  or  two),  or  with  cocaine  (a  small  portion),  or  a  part  of 
a  drop  of  dental  aconite,  as  indicated  ;  also  used  for  pulp  puncture. 

Mtric  Acid,  41°. — Used  for  obtunding  sensitive  dentine  and 
for  canker  sores.  Napkin  mouth  and  dry  canker  sore ;  touch 
sore  with  nitric  acid  on  pointed  stick  till  entirely  white ;  causes 
pain ;  obtunded  by  oil  of  cloves  on  pellet  of  cotton,  previously 
prepared. 

Pepper  Bag-s. — See  Capsicum  Bags. 

Peroxide  of  Hydrog-en. — ^Used  for  the  treatment  of  pus- 
making  surfaces ;  for  disinfecting  canals ;  for  treating  canker 
sores  in  the  mouths  of  children. 

Phenol  Sodique  (Hance  Bros.  &  White's). — Very  acceptable 
and  efficacious  medicament.  Pain  obtundent,  styptic,  detergent, 
antiseptic,  disinfectant,  stimulant;  is  a  useful  injection  for  fistulte  ; 
useful  as  a  mouth-wash ;  ten  to  thirty  drops  to  half  tumbler  of 
water. 

Piscidia  Erytlirina,  Fluid  Extract  of  (Jamaica  Dog- 
wood).— Used  in  difficult  devitalization  in  canals ;  is  notable  pain 
obtundent;  sedative;  applied  locally  and  administered  systemic- 
ally,  is  eminently  antineuralgic.  Systemic  dose,  one-half  tea- 
spoonful,  jjro  re  natd. 

Potash,  Chlorate  of. — Make  saturated  solution  in  water. 
Used  (either  full  strength  or  diluted,  as  is  agreeable)  to  hold  in 
the  mouth  in  cases  of  peridental  trouble  and  sore  mouth  generally  ; 
should  be  occasionally  swallowed  for  the  systemic  effect. 


102  DENTAL    PATHOLOGY    AND    THERAPEUTICS. 

Potassa,  Caustic  (in  sticks). 

R  Caustic  potassa,  -> 

Carbolic  acid  (crystal),  | ^^^^^  P^^*^"     (Robinson's  remedy.) 

Rub  together.  Used  for  sensitive  dentine  and  in  pyorrhoea 
alveolaris. 

Potassium,  Bromide  of. — When  given  for  the  relief  of 
dental  suffering,  should  administer  at  least  forty  grains,  and  more 
if  the  patient  is  accustomed  to  its  use ,   administer  in  water. 

Potassiumi,  Carbonate  of. — Fill  small  bottle  half  or  three- 
quarters  full ;  add  glycerine ;  rub  up  in  mortar ;  return  to  bottle  ; 
add  glycerine  as  used.  Used  in  sensitive  dentine ;  especially 
indicated  in  the  variety  about  necks  of  teeth ;  does  not  injure 
mucous  membrane. 

Potassium,  Hitrate  of. — Eminently  cooling.  Used  in  pulp 
cavity  in  severe  periodontitis.     (See  653.) 

Potassium  Ointment,  Iodide  of. 

R   Iodide  of  potassium,  ^i. 
Simple  cerate,  3  i. 

Add  one  drop  of  liquor  potassa  to  prevent   discoloration.     If 

ointment  crystallizes,  spatulate  before  using.     Used  for  indurations 

or  slowness  of  absorption. 

Potassium,  Permang-anate  of. — Used  in  strong  solution  for 
disinfecting  canals  ;  in  mild  solution  for  sweetening  the  breath. 

Quinia,  Sulpliate  of. — Antiperiodic ;  usually  an  excellent 
remedy  in  neuralgia,  but  clinical  experience  seems  to  show  that  it 
is  contra-indicated  in  dental  neuralgia. 

Red  Precipitate  Ointment. 

R  Red  oxide  of  mercury,  gr.  Ixii. 
Benzoated  cerate,  3 11. 

Is  a  good  lip  salve ;  relieves  rough,  scaly  and  cracked  lips. 

Application — Open  crack  and  rub  ointment  in;  do  this  for  sev^eral 

visits,  until  strong  cicatricial  tissue  is  formed. 

Salt  and  Water. — (Strength  of  ocean  water.) — Excellent 
stimulant  and  detergent  in  inflammation  of  the  mucous  mem- 
brane; also  useful  injection  for  fistulse. 


MEMORANDA. 


MEMORANDA. 


MEDICAMENTS.  103 


Sandarac  Varnisli. 

R  Oil  of  cinnamon,  ^ss. 
Oil  of  cloves,  ^ss. 
Alcohol,   ^i. 
Gum  sandarac,  q.  s. 

Used  to  saturate  cottons,  and  thus  render  them  more  subservient 
to  the  varied  requirements  of  maintenance  in  position,  exclusion 
of  moisture  and  retention  of  medicaments. 

Smelling^  Salts. 

B   Muriate  of  ammonia,  -i 

Bicarbonate  of  soda,    J     ^        P        • 
Oil  of  cloves,  a  few  drops. 

Place  simple  cerate  around  the  glass  stopper  of  the  bottle. 

Soda,  Bicarbonate  of. — (Ordinary  baking  soda.)  Used  in 
sensitive  dentine,  and  for  systemic  hyperacidity.     (See  190.) 

Styptic  Cotton. 

R  Monsel's  solution,  2  parts. 
Water,  1  part. 

Steep  absorbent  cotton  in  the  mixture  and  dry.  Used  as  adjunct 
in  cases  of  hemorrhage  requiring  mechanical  retention  of  the 
clot. 

Sulpliuric  Acid,  Dilute. 

R   Sulphuric  acid,  1  part. 
Water,  3  parts. 

As  a  Stimulant  injection,  seems  especially  indicated  in  con- 
nection with  cases  of  caries  and  necrosis. 

Sulpliuric  Acid,  Aromatic. 

Uses. — Same  as  of  the  dilute. 

Tannin. — Astringent  and  styptic.  Used  after  extraction  in 
cases  of  hemorrhage  or  insufficient  clotting ;  also  used  in  combi- 
nation with  glycerine  as  obtundent  in  sensitive  dentine. 

Tannin  and  Water. — Useful  as  astringent  for  external  use; 
to  be  applied  on  cloths. 


104  DENTAL    PATHOLOGY    AND    THERAPEUTICS. 

Tannin  No.  1. 

R   Tannin,  gi. 

Glycerine,  ^i. 

Mix  in  a  mortar  with  gentle  heat.  Obtundent  of  sensitive 
dentine. 

Tannin  No.  2. 

R  Tannin,  ^ii. 

Glycerine,  §i. 

More  powerful  obtundent  than  No.  1. 

Tartrate  of  Antimony  and  Potassium  (Tartar  Emetic). 
— Produces  vital  depression,  and  thereby  systemic  sedation. 

Dose. — One  grain  every  three  or  four  hours  to  slight  nausea. 
Always  inquire  of  patient  as  to  usual  effect  of  this  drug. 

Temporary  Stopping. 

R  White  wax,  1  dwt.  (full). 

Eed  gutta-percha  base-plate,  4  dwt. 
Precipitated  chalk,  4  dwt. 

Melt  wax  first ;  add  gutta-percha,  and  melt  thoroughly  ;  then 

add  chalk   in  small  quantities,  thoroughly  incorporating  it  with 

the  gutta-percha ;  partially  cool  and  roll  into  sticks  with  hands, 

and  afterwards  with  a  plate  of  glass.     Is  non-leaking.     Used  for 

covering  canal  medicaments  and  arsenical  applications;  for  filling 

bulbous  portion  of  pulp  cavity ;  as  intermediate. 

Veratria    Ointment. — Avoid  with  utmost  care  the  mouth 

and  eyes. 

R   Veratria,  gr.  xx. 
Simple  cerate,  3  i. 

Uses. — To  be  used  on  failure  of  aconitia  ointment  to  act,  or  to 
increase  the  action  of  aconitia ;  is  never  used  before  aconitia.  It 
produces  a  decided,  persistent,  irritating  or  burning  sensation 
analogous  to  nettle.  Use  in  pieces  the  size  of  a  quarter  of  a 
pea.     (Powerful  poison.) 

Veratrum  Viride,  Tincture  of. — Give  by  pulse.  Admin- 
ister two  or  three  drops  and  wait  several  hours  ;  then  reduce  pulse 
by  drop  doses,  and  keep  reduced  by  one  drop  each  two  or  three 
hours. 


MEMORANDA. 


MEMORANDA. 


MEDICAMENTS.  10^ 


Vineg-ar  and  Water. — Excellent  antiphlogistic  for  external 
use ;  to  be  applied  on  cloths. 

Zinc,  Chloride  of. — Deliquesce  crystals  in  a  saucer,  and 
pour  off  supernatant  liquid  for  use ;  keep  in  glass-stoppered 
bottle.  Used  in  sensitive  dentine  and  as  dernier  ressort  in  canals 
for  devitalization  ;  is  used  for  injection  of  fistulge  in  solutions  of 
varying  strengths,  from  powerfully  stimulant  to  mildly  detergent. 

Zinc,  Iodide  of. — (Full  strength.)     Stimulant  injection. 

Zinc,  Sulphate  of. — Stimulant  injection.     (See  696.) 


